Restoration of right ventricular function in the treatment of pulmonary arterial hypertension

Figures

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  Figure 1. Longitudinal visualisation of RVEF stratified for patients who reach or maintain the 45% threshold. P-values represent the change over time within each group. The red dotted line indicates the 45% cut-off. Dots and whiskers represent the mean±SEM. CMR, cardiac magnetic resonance; FU, follow-up; RVEF, right ventricular ejection fraction; RVEF≥45%@FU, patients with an RVEF ≥45% at first FU; RVEF<45%@FU, patients with an RVEF <45% at first FU.

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  Figure 2. Changes in mPAP and PVR as stratified by an RVEF of 45% @ FU. (A) Longitudinal visualisation of mPAP in RVEF≥45%@FU patients and RVEF<45%@FU patients. (B) Longitudinal visualisation of PVR in RVEF≥45%@FU patients and RVEF<45%@FU patients. P-values represent the change over time within each group by two-way repeated measures analysis of variance. Dots and whiskers represent the mean±SEM. FU, first follow-up; mPAP, mean pulmonary arterial pressure; PVR, pulmonary vascular resistance; RHC, right heart catheterisation; RVEF, right ventricular ejection fraction; RVEF≥45%@FU patients, patients with a right ventricular ejection fraction ≥45% at first FU; RVEF<45%@FU patients, patients with an RVEF<45% at first FU.

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  Figure 3. Absolute change in RVEF for baseline RVEDVi and RVESVi quintiles. (A) Absolute change in RVEF for baseline RVEDVi subdivided into quintiles. (B) Absolute change in RVEF for baseline RVESVi subdivided into quintiles. P-values represent significant change in RVEF for each RVEDVi and RVESVi quintile determined through pairwise t-tests. Values above the x-axis represent portion of patients reaching the 45% RVEF threshold. The red dotted line indicates the 45% cut-off. Dots and whiskers represent the mean±SEM. CMR, cardiac magnetic resonance; FU, first follow-up; RVEDVi, right ventricular end-diastolic volume index; RVEF, right ventricular ejection fraction; RVESVi, right ventricular end-systolic volume index.

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  Figure 4. Survival stratified for patients with RVEF≥45%@FU compared with RVEF<45%@FU patients. FU, first follow-up; PAH, pulmonary arterial hypertension; RVEF, right ventricular ejection fraction. Log-rank test shows a significant different survival between both groups starting from first follow-up (p=0.018).

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  Figure 5. Longitudinal visualisation of RVEF in RVEF≥45%@FU patients and RVEF<45%@FU patients. (A) RVEF trajectory during follow-up for RVEF≥45%@FU patients and RVEF<45%@FU patients at two consecutive follow-up visits. (B) RVEF trajectory during follow-up for RVEF≥45%@FU patients and RVEF<45%@FU patients at three consecutive follow-up visits. The red dotted line indicates the 45% cut-off. Dots and whiskers represent the mean±SEM. CMR, cardiac magnetic resonance; FU 1, first follow-up visit; FU 2, second follow-up visit; FU 3, third follow-up visit; RVEF, right ventricular ejection fraction; RVEF≥45%@FU, patients with a right ventricular ejection fraction ≥45% at first FU; RVEF<45%@FU, patients with an RVEF<45% at first FU. Repeated measures analysis of variance shows a significant different trajectory between both groups (p<0.001).

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  Figure 6. Summary of longitudinal results for RVEF≥45%@FU patients vs. RVEF<45%@FU patients. Of 127 treatment-naive patients with PAH who underwent RHC and CMR during initial diagnostic work-up and first follow-up, n=75 reach the RVEF 45% threshold. During long-term clinical monitoring with CMR, these patients mostly stay above the RVEF 45% threshold and have a more favourable prognosis. CMR, cardiac magnetic resonance imaging; FU 1, first follow-up visit; FU 2, second follow-up visit; FU 3, third follow-up visit.; mPAP, mean pulmonary arterial pressure; PAH, pulmonary arterial hypertension; PVR, pulmonary vascular resistance; RHC, right heart catheterisation; RV, right ventricular; RVEF, right ventricular ejection fraction; RVEF≥45%@FU, patients with a right ventricular ejection fraction ≥45% at first FU; RVEF<45%@FU, patients with an RVEF<45% at first FU. The red dotted line indicates the RVEF 45% threshold.