Cardiac magnetic resonance-derived right ventricular outflow tract systolic flow acceleration: a novel index of right ventricular function and prognosis in patients with pulmonary arterial hypertension

• Published in: The International Journal of Cardiovascular Imaging 2013-12, Vol.29 (8), p.1759-1767
• Main Authors: Kang, Ki-Woon, Chang, Hyuk-Jae, Yoo, Yeon Pyo, Yoon, Hyeon Soo, Kim, Young-Jin, Choi, Byoung-Wook, Shim, Chi-Young, Ha, Jongwon, Chung, Namsik
• Format: Article
• Language: English
• Subjects: Acceleration; Adult; Area Under Curve; Cardiac Catheterization; Cardiac Imaging; Cardiology; Familial Primary Pulmonary Hypertension; Female; Hemodynamics; Humans; Hypertension, Pulmonary - complications; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - physiopathology; Imaging; Magnetic Resonance Imaging, Cine; Male; Medicine; Medicine & Public Health; Middle Aged; Myocardial Contraction; Original Paper; Predictive Value of Tests; Prognosis; Prospective Studies; Radiology; Reproducibility of Results; ROC Curve; Stroke Volume; Time Factors; Ventricular Dysfunction, Right - diagnosis; Ventricular Dysfunction, Right - etiology; Ventricular Dysfunction, Right - physiopathology; Ventricular Function, Right; Ventricular Pressure
• ISSN: 1569-5794; 1573-0743; 1875-8312
• DOI: 10.1007/s10554-013-0262-2

To validate the right ventricular outflow tract systolic flow acceleration (RVOT ACC ; peak flow velocity/time-to-peak velocity) measured by phase-contrast (PC)—cardiovascular magnetic resonance (CMR) as a novel index of right ventricular (RV) function, and to investigate its clinical implications in patients with pulmonary arterial hypertension (PAH). Thirty (38 % male, 43 ± 15 years old) out of 55 consecutive patients who were initially diagnosed with PAH at the referral center were prospectively enrolled between March 2009 and July 2010 and were followed for PAH-related cardiovascular events for 2 years. The invasively measured maximum dP/dt (dP/dt max ) was used as an index of RV contractility. The PC-CMR-derived RVOT ACC was compared with well-known prognostic parameters. The PC-CMR-derived RVOT ACC correlated strongly with the dP/dt max and estimated RV function more accurately than the CMR-derived RV ejection fraction. The CMR-derived RVOT ACC level (HR = 0.87, 95 % CI 0.78–0.98, p  = 0.038) could be another powerful prognostic index compared with the functional capacity (hazard ratio [HR] = 0.88, 95 % confidence interval [CI] 0.78–0.97, p  = 0.035) and REVEAL Registry risk score (HR = 0.83, CI 0.56–0.95, p  = 0.012). Furthermore, receiver-operating characteristic analysis identified ≥0.4 m/s 2 as the optimal RVOT ACC cut-off for predicting subsequent cardiovascular events. PC-CMR-derived RVOT ACC is a promising non-invasively measured index of RV function and prognosis in patients with PAH.