Key result
Right ventricular ejection fraction (OR 0.95) and age, but not right atrial area, were independent predictors of 1-year mortality in treatment-naïve patients with pulmonary arterial hypertension.
Why the study?
Guidelines recommend regular risk stratification to treat pulmonary arterial hypertension patients to maintain low-risk status, but whether right ventricular assessment should be included remains to be determined.
Do right ventricular function metrics derived from cMRI improve risk stratification for 1-year mortality compared to right atrial area in patients with pulmonary arterial hypertension?
Cohort (n=311)
No
Do right ventricular function metrics derived from cMRI improve risk stratification for 1-year mortality compared to right atrial area in patients with pulmonary arterial hypertension?
Odds Ratio: 0.95 (95% CI 0.92–0.98)
p-value: p=<0.01
Cardiac MRI-derived right ventricular metrics, but not right atrial area, independently predict 1-year mortality and successfully identify low-risk patients in pulmonary arterial hypertension.
RV ejection fraction may refine 1-year mortality prediction in treatment-naïve PAH; leaves open prospective validation of cMRI metrics versus right atrial area.
Background Current European Society of Cardiology and European Respiratory Society guidelines recommend regular risk stratification with an aim of treating patients with pulmonary arterial hypertension (PAH) to improve or maintain low-risk status (<5% 1-year mortality). Methods Consecutive patients with PAH who underwent cardiac magnetic resonance imaging (cMRI) were identified from the Assessing the Spectrum of Pulmonary hypertension Identified at a Referral centre (ASPIRE) registry. Kaplan–Meier survival curves, locally weighted scatterplot smoothing regression and multi-variable logistic regression analysis were performed. Results In 311 consecutive, treatment-naïve patients with PAH undergoing cMRI including 121 undergoing follow-up cMRI, measures of right ventricular (RV) function including right ventricular ejection fraction (RVEF) and RV end systolic volume and right atrial (RA) area had prognostic value. However, only RV metrics were able to identify a low-risk status. Age (p < 0.01) and RVEF (p < 0.01) but not RA area were independent predictors of 1-year mortality. Conclusion This study highlights the need for guidelines to include measures of RV function rather than RA area alone to aid the risk stratification of patients with PAH.
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Alandejani et al. (2022) conducted a cohort in Pulmonary arterial hypertension (n=311). Right ventricular ejection fraction (RVEF) vs. Right atrial (RA) area was evaluated on 1-year mortality (OR 0.95, 95% CI 0.92-0.98, p=<0.01). Right ventricular ejection fraction (OR 0.95) and age, but not right atrial area, were independent predictors of 1-year mortality in treatment-naïve patients with pulmonary arterial hypertension.
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