Cardiac MRI-derived mean right atrial pressure and its prognostic importance

Figures

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  Figure 1. Two case examples from the study. (a) Case example of normal invasive right atrial pressure (RAP of 7 mm Hg). (b) Case example of a patient with a dilated right atrium and significantly compromised right atrial function (volume curves are flattened) with raised invasive mean RAP (mRAP) of 10 mm Hg. CMR, cardiovascular magnetic resonance.

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  Figure 2. (a) Correlogram of invasive mRAP to several CMR right heart indices. (b) Scatter plot with heat map showing the association between RAESV and invasive mRAP. *P≤0.05. CMR, cardiovascular magnetic resonance; mRAP, mean right atrial pressure; RAEDV, right atrial end-diastolic volume; RAEF, right atrial ejection fraction; RAESV, right atrial end-systolic volume.

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  Figure 3. Internal validation checks. (a) Three physiological models to estimate invasive mRAP. Model 1 only incorporates RAESV, model 2 incorporates RAESV and peak strain, whereas model 3 incorporates RAESV and right ventricular volumes. Model 4 includes RAESV corrected for sex and body surface area. There is no significant difference in diagnostic power using models 2, 3 or 4 over model 1, which remains the simplest. (b) Model 1 ROC with 95% CI presented in light blue with an mRAP threshold of 8 mm Hg. AUC, area under the curve; mRAP, mean right atrial pressure; RAESV, right atrial end-systolic volume; ROC, receiver operating characteristic.

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  Figure 4. Clinical outcomes cohort results. (a) ROC curve of CMR-derived mRAP to detect peripheral pitting oedema in patients (events=10). (b) ROC curve of CMR-derived mRAP for hospitalisation (events=3). AUC, area under the curve; CMR, cardiovascular magnetic resonance; mRAP, mean right atrial pressure; ROC, receiver operating characteristic.

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  Figure 5. Clinical outcomes cohort to investigate the prognostic role of mRAP. (a) Kaplan-Meier curves demonstrate that CMR-derived mRAP >10 mm Hg is associated with an increased risk of all-cause mortality. (b) Cox-regression survival curves demonstrate that the risk of all-cause mortality remains high in patients with CMR-derived mRAP >10 mm Hg even after adjusting for age, sex and left ventricular ejection fraction. CMR, cardiovascular magnetic resonance; mRAP, mean right atrial pressure.

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  Figure 6. Bar chart of CMR-derived mRAP (y-axis), stratified by the number of outcomes patients experienced (oedema, hospitalisation, death); 0 being the absence of any outcome, 3 being suffering all measured adverse outcomes. CMR, cardiovascular magnetic resonance; HF, heart failure; mRAP, mean right atrial pressure.