Key result
In patients with chronic thromboembolic pulmonary hypertension, higher left atrial volume index measured by CMR was an independent predictor of increased mortality (HR 1.015 per ml/m2 increase).
Why the study?
Providing prognostic information is important for counseling and planning treatment in CTEPH, but the prognostic value of CMR measures of cardiac structure and function needed assessment.
Do CMR measures of cardiac structure and function predict mortality in patients with CTEPH?
Cohort (n=375)
Single-blind (image analysis blinded to clinical information)
No
Do CMR measures of cardiac structure and function predict mortality in patients with CTEPH?
CMR measures of cardiac function and left heart disease, specifically LAVI in PEA patients and RVEF%pred in non-PEA patients, have independent prognostic value for mortality in CTEPH.
May aid mortality risk stratification by PEA status in CTEPH; leaves open prospective validation of CMR measures.
Providing prognostic information is important when counseling patients and planning treatment strategies in chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to assess the prognostic value of gold standard imaging of cardiac structure and function using cardiac magnetic resonance imaging (CMR) in CTEPH. Consecutive treatment-naive patients with CTEPH who underwent right heart catheterization and CMR between 2011 and 2017 were identified from the ASPIRE (Assessing-the-Specturm-of-Pulmonary-hypertensIon-at-a-REferral-center) registry. CMR metrics were corrected for age and sex where appropriate. Univariate and multivariate regression models were generated to assess the prognostic ability of CMR metrics in CTEPH. Three hundred and seventy-five patients (mean+/-standard deviation: age 64+/-14 years, 49% female) were identified and 181 (48%) had pulmonary endarterectomy (PEA). For all patients with CTEPH, left-ventricular-stroke-volume-index-%predicted (LVSVI%predicted) (p = 0.040), left-atrial-volume-index (LAVI) (p = 0.030), the presence of comorbidities, incremental shuttle walking test distance (ISWD), mixed venous oxygen saturation and undergoing PEA were independent predictors of mortality at multivariate analysis. In patients undergoing PEA, LAVI (p < 0.010), ISWD and comorbidities and in patients not undergoing surgery, right-ventricular-ejection-fraction-%predicted (RVEF%pred) (p = 0.040), age and ISWD were independent predictors of mortality. CMR metrics reflecting cardiac function and left heart disease have prognostic value in CTEPH. In those undergoing PEA, LAVI predicts outcome whereas in patients not undergoing PEA RVEF%pred predicts outcome. This study highlights the prognostic value of imaging cardiac structure and function in CTEPH and the importance of considering left heart disease in patients considered for PEA.
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Shahin et al. (2022) conducted a cohort in Chronic Thromboembolic Pulmonary Hypertension (CTEPH) (n=375). Left atrial volume index (LAVI) and right ventricular function metrics via CMR was evaluated on All-cause mortality (HR 1.015, 95% CI 1.001-1.028, p=0.033). In patients with chronic thromboembolic pulmonary hypertension, higher left atrial volume index measured by CMR was an independent predictor of increased mortality (HR 1.015 per ml/m2 increase).
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