Right ventricular remodelling in pulmonary arterial hypertension predicts treatment response

作者：Ze Ming Goh, Nithin Balasubramanian, Samer Alabed, Krit Dwivedi, Yousef Shahin, Alexander Rothman, Pankaj Garg, Allan Lawrie, David Capener, A. A. Roger Thompson, Faisal Alandejani, Jim M. Wild, Christopher S Johns, Robert A. Lewis, Rebecca Gosling, Michael Sharkey, Robin Condliffe, David G. Kiely, Andrew J. Swift · 发表于：Heart · 年份：2022 · DOI：10.1136/heartjnl-2021-320733 · 被引用次数：37 · 研究领域：Pulmonary Hypertension Research and Treatments、Congenital Heart Disease Studies、Cardiovascular Function and Risk Factors

OBJECTIVES: To determine the prognostic value of patterns of right ventricular adaptation in patients with pulmonary arterial hypertension (PAH), assessed using cardiac magnetic resonance (CMR) imaging at baseline and follow-up. METHODS: Patients attending the Sheffield Pulmonary Vascular Disease Unit with suspected pulmonary hypertension were recruited into the ASPIRE (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral Centre) Registry. With exclusion of congenital heart disease, consecutive patients with PAH were followed up until the date of census or death. Right ventricular end-systolic volume index adjusted for age and sex and ventricular mass index were used to categorise patients into four different volume/mass groups: low-volume-low-mass, low-volume-high-mass, high-volume-low-mass and high-volume-high-mass. The prognostic value of the groups was assessed with one-way analysis of variance and Kaplan-Meier plots. Transition of the groups was studied. RESULTS: A total of 505 patients with PAH were identified, 239 (47.3%) of whom have died at follow-up (median 4.85 years, IQR 4.05). The mean age of the patients was 59±16 and 161 (32.7%) were male. Low-volume-low-mass was associated with CMR and right heart catheterisation metrics predictive of improved prognosis. There were 124 patients who underwent follow-up CMR (median 1.11 years, IQR 0.78). At both baseline and follow-up, the high-volume-low-mass group had worse prognosis than the low-volume-lo...