Key result
Every 10% higher ventricular mass index measured by cardiac magnetic resonance was associated with 52% greater odds of having pulmonary arterial hypertension.
Why the study?
It was hypothesized that RV mass-based metrics would discriminate incident PAH under the lower mean pulmonary arterial pressure threshold of >20 mmHg introduced at the 6th WSPH.
Does CMR-derived ventricular mass index discriminate incident PAH defined by 6th WSPH criteria in subjects with suspected PAH?
Cohort (n=89)
No
Does CMR-derived ventricular mass index discriminate incident PAH defined by 6th WSPH criteria in subjects with suspected PAH?
Answers are grounded in this paper and cite their sources.
CMR-derived right ventricular mass metrics, particularly ventricular mass index, can accurately discriminate incident, treatment-naïve PAH using the updated 6th WSPH criteria.
Cardiac magnetic resonance (CMR) measures of right ventricular (RV) mass, volumes, and function have diagnostic and prognostic value in pulmonary arterial hypertension (PAH). We hypothesized that RV mass-based metrics would discriminate incident PAH as redefined by the lower mean pulmonary arterial pressure (mPAP) threshold of >20 mmHg at the Sixth World Symposium on Pulmonary Hypertension (6th WSPH). Eighty-nine subjects with suspected PAH underwent CMR imaging, including 64 subjects with systemic sclerosis (SSc). CMR metrics, including RV and left ventricular (LV) mass, were measured. All subjects underwent right heart catheterization (RHC) for assessment of hemodynamics within 48 h of CMR. Using generalized linear models, associations between CMR metrics and PAH were assessed, the best subset of CMR variables for predicting PAH were identified, and relationships between mass-based metrics, hemodynamics, and other predictive CMR metrics were examined. Fifty-nine subjects met 6th WSPH criteria for PAH. RV mass metrics, including ventricular mass index (VMI), demonstrated the greatest magnitude difference between subjects with versus without PAH. Overall and in SSc, VMI and RV mass measured by CMR were among the most predictive variables discriminating PAH at RHC, with areas under the receiver operating characteristic curve 0.86 and 0.83. respectively. VMI increased linearly with pulmonary vascular resistance and with mPAP in PAH, including in lower ranges of mPAP associated with mild PAH. VMI ≥ 0.37 yielded a positive predictive value of 90% for discriminating PAH. RV mass metrics measured by CMR, including VMI, discriminate incident, treatment-naïve PAH as defined by 6th WSPH criteria.
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Simpson et al. (2021) conducted a cohort in Suspected pulmonary arterial hypertension (n=89). Ventricular mass index (VMI) vs. Lower VMI was evaluated on Presence of pulmonary arterial hypertension at right heart catheterization (OR 1.52, 95% CI 1.25-1.84, p=<0.001). Every 10% higher ventricular mass index measured by cardiac magnetic resonance was associated with 52% greater odds of having pulmonary arterial hypertension.
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