Key result
Mean pulmonary artery velocity ≤9 cm/s predicts ~78% higher risk of death or HF readmission in new-onset HFrEF.
Why the study?
Pulmonary hypertension worsens prognosis in heart failure, and early alterations in RV-PA coupling occur before significant pulmonary vascular resistance rise; the prognostic value of mean velocity at the pulmonary artery (mvPA) by CMR in new-onset HFrEF was unknown.
Does mean velocity at the pulmonary artery (mvPA) measured by CMR predict the composite of HF readmissions and all-cause mortality in patients with new-onset HFrEF?
Cohort (n=210)
No
Does mean velocity at the pulmonary artery (mvPA) measured by CMR predict the composite of HF readmissions and all-cause mortality in patients with new-onset HFrEF?
Mean velocity at the pulmonary artery (mvPA) ≤9 cm/s measured by CMR is an independent predictor of mortality and HF readmissions in patients with new-onset HFrEF, serving as a surrogate marker of RV-PA coupling.
Answers are grounded in this paper and cite their sources.
mvPA ≤9 cm/s on CMR may identify higher-risk new-onset HFrEF; leaves open incremental value of RV-PA coupling assessment pending prospective validation.
BACKGROUND: Pulmonary hypertension (PH) conveys a worse prognosis in heart failure (HF), in particular when right ventricular (RV) dysfunction ensues. Cardiovascular magnetic resonance (CMR) non-invasively estimates pulmonary vascular resistance (PVR), which has shown prognostic value in HF. Importantly, RV to pulmonary artery (PA) coupling is altered early in HF, before significant rise in PV resistance occurs. The aim of this study was to assess the prognostic value of mean velocity at the pulmonary artery (mvPA), a novel non-invasive parameter determined by CMR, in HF with reduced ejection fraction (HFrEF) with and without associated PH. METHODS: Prospective inclusion of 238 patients admitted for new-onset HFrEF. MvPA was measured with CMR during index admission. The primary endpoint was defined as a composite of HF readmissions and all-cause mortality. RESULTS: During a median follow-up of 25 months, 91 patients presented with the primary endpoint. Optimal cut-off value of mvPA calculated by the receiver operator curve for the prediction of the primary endpoint was 9 cm/s. The primary endpoint occurred more frequently in patients with mvPA≤9 cm/s, as indicated by Kaplan-Meier survival curves; Log Rank 16.0, p < 0.001. Importantly, mvPA maintained its prognostic value regardless of RV function and also when considering mortality and HF readmissions separately. On Cox proportional hazard analysis, reduced mvPA≤9 cm/s emerged as an independent prognostic marker, together with NYHA III-IV/IV class, stage 3-4 renal failure and ischemic cardiomyopathy. CONCLUSIONS: In our HFrEF cohort, mvPA emerged as an independent prognostic indicator independent of RV function, allowing identification of a higher-risk population before structural damage onset. Moreover, mvPA emerged as a surrogate marker of the RV-PA unit coupling status.
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Trejo‐Velasco et al. (2020) conducted a cohort in New-onset heart failure with reduced ejection fraction (HFrEF) (n=210). Mean velocity at the pulmonary artery (mvPA) ≤9 cm/s vs. mvPA > 9 cm/s was evaluated on Composite of heart failure readmissions and all-cause mortality (HR 1.782, 95% CI 1.105-2.874, p=0.018). A mean velocity at the pulmonary artery ≤9 cm/s independently predicted a higher risk of heart failure readmissions and all-cause mortality in patients with new-onset HFrEF.
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