Key result
Increased right atrial maximum volume measured with CMR was associated with worse transplantation-free survival in patients with pre-capillary pulmonary hypertension (HR 2.1; 95% CI 1.1-4.0).
Why the study?
Does increased right atrial volume measured with cardiac magnetic resonance predict death or lung transplantation in patients with pre-capillary pulmonary hypertension?
Cohort (n=75)
Does increased right atrial volume measured with cardiac magnetic resonance predict death or lung transplantation in patients with pre-capillary pulmonary hypertension?
Hazard Ratio: 2.1 (95% CI 1.1–4)
Increased right atrial volume measured by cardiac magnetic resonance is associated with worse transplantation-free survival in patients with pre-capillary pulmonary hypertension.
Aims Pre-capillary pulmonary hypertension (PHpre-cap) has a poor prognosis, especially when caused by pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SSc-PAH). Whether cardiac magnetic resonance (CMR)-based quantification of atrial volumes in PHpre-cap is beneficial in risk assessment is unknown. The aims were to investigate if (i) atrial volumes using CMR are associated with death or lung transplantation in PHpre-cap, (ii) atrial volumes differ among four unmatched major PHpre-cap subgroups, and (iii) atrial volumes differ between SSc-PAH and idiopathic/familial PAH (IPAH/FPAH) when matched for pulmonary vascular resistance (PVR). Methods and results Seventy-five PHpre-cap patients (57 ± 19 years, 53 female, 43 de novo) with CMR and right heart catheterization were retrospectively included. Short-axis stacks of cine images were analysed, and right and left atrial maximum (RAVmax and LAVmax) and minimum volume (RAVmin and LAVmin) were indexed for body surface area. Increased (mean + 2 SD) and reduced (mean – 2 SD) volumes were predefined from CMR normal values. Transplantation-free survival was lower in patients with increased RAVmax than in those with normal [hazard ratio (HR) = 2.1, 95% confidence interval (CI) 1.1–4.0] but did not differ between those with reduced LAVmax and normal (HR 2.0, 95% CI 0.8–5.1). RAVmax and RAVmin showed no differences among unmatched or matched groups (P = ns). When matched for PVR, LAVmax, LAVmin, and pulmonary artery wedge pressure were reduced in SSc-PAH compared with IPAH/FPAH (95% CI 0.3–21.4, 95% CI 0.8–19.6, and 95% CI 2–7, respectively). Conclusions Patients with PHpre-cap and increased right atrial volume measured with CMR had worse clinical outcome. When matched for PVR, left atrial volume was lower in SSc-PAH than in IPAH/FPAH, consistent with left-sided underfilling, indicating a potential differentiator between the groups.
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Bredfelt et al. (2018) conducted a cohort in Pre-capillary pulmonary hypertension (n=75). Increased right atrial maximum volume (RAVmax) vs. Normal right atrial maximum volume was evaluated on Transplantation-free survival (death or lung transplantation) (HR 2.1, 95% CI 1.1-4.0). Increased right atrial maximum volume measured with CMR was associated with worse transplantation-free survival in patients with pre-capillary pulmonary hypertension (HR 2.1; 95% CI 1.1-4.0).
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