The Role of Strain by Cardiac Magnetic Resonance Imaging in Predicting the Prognosis of Patients with Chronic Thromboembolic Pulmonary Hypertension

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic thromboembolic pulmonary hypertension (CTEPH) (n=45). Intervention: Right ventricular global longitudinal strain (RVGLS) derived by cardiac magnetic resonance vs. Lower vs higher baseline RVGLS. Primary outcome: Composite of all-cause death and hospitalization due to worsening heart failure (HR 1.148, 95% CI 1.012-1.301, p=0.032).

Xuefei Zhang; Xiaojuan Guo; Bowen Zhang; Qi Yang; Juanni Gong; Suqiao Yang; Jifeng Li; Tuguang Kuang; Ran Miao; Yuanhua Yang

doi:10.1177/10760296231176253

January 1, 2023Clinical and Applied Thrombosis/HemostasisOpen Access

The Role of Strain by Cardiac Magnetic Resonance Imaging in Predicting the Prognosis of Patients with Chronic Thromboembolic Pulmonary Hypertension

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Key result

Impaired right ventricular global longitudinal strain derived by cardiac magnetic resonance was an independent predictor for the composite of all-cause death and heart failure hospitalization (HR 1.148).

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Why the study?

Right ventricular dysfunction is a major cause of death in chronic thromboembolic pulmonary hypertension, leading researchers to determine the prognostic value of CMR-derived strain in these patients.

Does right ventricular strain by cardiac magnetic resonance imaging predict the prognosis of patients with chronic thromboembolic pulmonary hypertension?

Key Points

To evaluate the prognostic value of right ventricular strain measured by cardiac magnetic resonance imaging in patients diagnosed with chronic thromboembolic pulmonary hypertension.
Assessed baseline right ventricular strain using cardiac magnetic resonance (CMR) in 45 patients with chronic thromboembolic pulmonary hypertension (CTEPH) and 20 healthy controls.
Tracked clinical endpoints (all-cause mortality and heart failure hospitalization) over a median follow-up of 40 months (IQR 29 to 53 months).
Calculated optimal strain cut-offs using the Youden index and evaluated multivariable Cox regression models and net reclassification improvement alongside established risk scores.
Baseline RV global longitudinal strain (GLS: -10.6% vs -19.6%, P < .001) and global circumferential strain (GCS: -7.4% vs -12.9%, P < .001) were significantly impaired in CTEPH patients versus controls.
Ten patients experienced adverse events (5 deaths, 5 hospitalizations), with basal longitudinal strain and GLS serving as independent predictors of outcomes (P < .050).
Adding RVGLS with a cut-off of -7.665% to standard risk stratification significantly improved classification accuracy (NRI = 8.6%, P < .001), achieving a multivariable C-index of 0.94 when paired with basal strain.

Study Design

Type

Cohort (n=45)

Multicenter

No

Structured PICO

Does right ventricular strain by cardiac magnetic resonance imaging predict the prognosis of patients with chronic thromboembolic pulmonary hypertension?

P

Population

45 adults with chronic thromboembolic pulmonary hypertension, mean age 57, 38% female, evaluated by cardiac magnetic resonance and followed for a median of 40 months.

E

Exposure

Right ventricular global longitudinal strain (RVGLS) and global peak circumferential strain (GCS) assessment by cardiac magnetic resonance (CMR).

C

Comparator

Within-cohort comparison by strain parameters (e.g., RVGLS ≥ -7.665% vs < -7.665%) and against non-PH control patients.

O

Outcome

Composite of all-cause death and hospitalization due to worsening heart failure.composite

Main Result

Hazard Ratio: 1.148 (95% CI 1.012–1.301)

p-value: p=0.032

Limitations

Single-center study with a relatively small sample size
Evaluated variables only at baseline and did not utilize data from follow-up visits
Retrospective study design requiring prospective validation
Used previously reported healthy control values instead of direct healthy controls for strain parameter comparison
Only focused on the right ventricular-free wall
Inconsistent follow-up period may have resulted in underestimating adverse events

Implication

Cardiac magnetic resonance derived right ventricular strain, specifically global longitudinal strain, serves as a powerful noninvasive prognostic tool in patients with CTEPH.

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by thrombotic obstruction of the pulmonary arteries, and right ventricular (RV) dysfunction is a major cause of death. Cardiac magnetic resonance (CMR) is the gold standard for assessing heart wall deformation; therefore, we aimed to determine the prognostic value of CMR strain in patients with CTEPH. Strain derived by CMR was measured at the time of diagnosis in 45 patients with CTEPH, and the relationship between RV strain and prognosis was determined through follow-up. The value of RV strain in the prognostic model was compared with that of pulmonary arterial hypertension (PAH) risk stratification. The RV global peak longitudinal strain (GLS) and global peak circumferential strain (GCS) in CTEPH patients were lower than the normal references of RV strain in the control group. GLS and longitudinal strain in the basal segment were independent risk factors for adverse events ( P < .050). Adding CMR parameters to PAH risk stratification improved its predictive power in patients with CTEPH. GLS and GCS scores were impaired in patients with chronic RV overload. RV strain derived by CMR imaging is a promising noninvasive tool for the follow-up of patients with CTEPH.

Discussion

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Cite This Study

Zhang et al. (2023) conducted a cohort in Chronic thromboembolic pulmonary hypertension (CTEPH) (n=45). Right ventricular global longitudinal strain (RVGLS) derived by cardiac magnetic resonance vs. Lower vs higher baseline RVGLS was evaluated on Composite of all-cause death and hospitalization due to worsening heart failure (HR 1.148, 95% CI 1.012-1.301, p=0.032). Impaired right ventricular global longitudinal strain derived by cardiac magnetic resonance was an independent predictor for the composite of all-cause death and heart failure hospitalization (HR 1.148).

synapsesocial.com/papers/6a22a4aab67b8d1b1fd2bf78 https://doi.org/10.1177/10760296231176253

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The Role of Strain by Cardiac Magnetic Resonance Imaging in Predicting the Prognosis of Patients with Chronic Thromboembolic Pulmonary Hypertension

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

The Role of Strain by Cardiac Magnetic Resonance Imaging in Predicting the Prognosis of Patients with Chronic Thromboembolic Pulmonary Hypertension

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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