Key result
WHO functional class change links to ~11% shift in RV volume in PAH.
Why the study?
RV dilatation predicts clinical worsening in PAH, but knowledge of what constitutes clinically significant changes in RV volumes and function during follow-up was needed.
Does a change in WHO functional class correlate with clinically significant changes in right ventricular volume and function in patients with pulmonary arterial hypertension?
Cohort (n=25)
No
Does a change in WHO functional class correlate with clinically significant changes in right ventricular volume and function in patients with pulmonary arterial hypertension?
Effect estimate: 11% change (95% CI 7%-14%)
p-value: p=< 0.0001
An 11% change in right ventricular end-diastolic volume measured by cardiac MRI represents a clinically significant difference tied to WHO functional class changes in PAH patients.
Right ventricular (RV) dilatation predicts clinical worsening in pulmonary arterial hypertension (PAH) and RV volumes can be measured with high precision using cardiovascular magnetic resonance imaging. In regular follow‐up of patients and in studies of improvement in RV function, knowledge of clinically significant changes of RV volumes and function are of relevance. Patients with PAH were followed with cardiovascular magnetic resonance imaging and clinical assessment at 6‐month intervals. Changes in RV volumes associated with changes in clinical status were assessed. Twenty‐five patients with PAH (Group 1) were included and examined every 6 months for 2.5 years, with a total of 107 MRI scans. For a step change in WHO functional class, the associated change in RV volume was 11% (confidence interval 7%−14%, p < 0.0001) and in stroke volume 9% (confidence interval 3%−15%, p = 0.003). This study found an 11% change in RV volume to be clinically significant. The combination of clinically significant changes and the known precision in the measurements enables individualized follow‐up of RV‐function in PAH. To our knowledge, this study is the first to use repeated assessments to suggest clinically significant changes of RV volume based on changes in clinical presentation.
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Göransson et al. (2022) conducted a cohort in Pulmonary arterial hypertension (n=25). Step change in WHO functional class was evaluated on Change in right ventricular end-diastolic volume associated with a step change in WHO functional class (11% change, 95% CI 7%-14%, p=< 0.0001). A step change in WHO functional class was associated with an 11% change in right ventricular volume, establishing a clinically significant threshold for CMR assessments in PAH.
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