Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK.
Heart. 2022 Aug 11;108(17):1392-1400. doi: 10.1136/heartjnl-2021-320733.
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.
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.
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-low-mass group (p<0.001). With PAH therapy, 73.5% of low-volume-low-mass patients remained in this group, whereas only 17.4% of high-volume-low-mass patients transitioned into low-volume-low-mass.
Right ventricular adaptation assessed using CMR has prognostic value in patients with PAH. Patients with maladaptive remodelling (high-volume-low-mass) are at high risk of treatment failure.
通过心脏磁共振（CMR）成像在基线和随访时评估肺动脉高压（PAH）患者的右心室适应模式，确定其预后价值。
我们招募了在谢菲尔德肺血管疾病中心就诊的疑似肺动脉高压患者进入 ASPIRE（评估在转诊中心确定的肺动脉高压谱）登记处。排除先天性心脏病后，连续的 PAH 患者被随访至普查日或死亡。使用校正年龄和性别后的右心室收缩末期容积指数和心室质量指数将患者分为四个不同的容积/质量组：低容积低质量组、低容积高质量组、高容积低质量组和高容积高质量组。通过单因素方差分析和 Kaplan-Meier 图评估各组的预后价值。研究了各组的转变情况。
共确定了 505 例 PAH 患者，其中 239 例（47.3%）在随访时死亡（中位随访时间为 4.85 年，IQR 为 4.05）。患者的平均年龄为 59±16 岁，161 例（32.7%）为男性。低容积低质量与 CMR 和右心导管检查预测预后改善的指标相关。有 124 例患者接受了随访 CMR（中位随访时间为 1.11 年，IQR 为 0.78）。在基线和随访时，高容积低质量组的预后均比低容积低质量组差（p<0.001）。在接受 PAH 治疗后，73.5%的低容积低质量患者仍保持在该组，而只有 17.4%的高容积低质量患者转变为低容积低质量组。
通过 CMR 评估的右心室适应性在 PAH 患者中有预后价值。适应性不良（高容积低质量）的患者发生治疗失败的风险很高。
