1. Late gadolinium enhancement cardiovascular magnetic resonance predicts clinical worsening in patients with pulmonary hypertension.
- Author
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Freed BH, Gomberg-Maitland M, Chandra S, Mor-Avi V, Rich S, Archer SL, Jamison EB Jr, Lang RM, and Patel AR
- Subjects
- Adult, Aged, Biomarkers blood, Blood Pressure, Cardiac Catheterization, Chi-Square Distribution, Chicago, Disease Progression, Exercise Test, Female, Heart Failure etiology, Heart Failure physiopathology, Humans, Hypertension, Pulmonary blood, Hypertension, Pulmonary complications, Hypertension, Pulmonary mortality, Hypertension, Pulmonary physiopathology, Kaplan-Meier Estimate, Linear Models, Male, Middle Aged, Multivariate Analysis, Natriuretic Peptide, Brain blood, Peptide Fragments blood, Predictive Value of Tests, Prognosis, Proportional Hazards Models, Pulmonary Artery physiopathology, Risk Assessment, Risk Factors, Stroke Volume, Time Factors, Ventricular Dysfunction, Right blood, Ventricular Dysfunction, Right etiology, Ventricular Dysfunction, Right mortality, Ventricular Dysfunction, Right physiopathology, Ventricular Function, Right, Contrast Media, Gadolinium DTPA, Hypertension, Pulmonary diagnosis, Magnetic Resonance Imaging, Ventricular Dysfunction, Right diagnosis
- Abstract
Background: Late gadolinium enhancement (LGE) occurs at the right ventricular (RV) insertion point (RVIP) in patients with pulmonary hypertension (PH) and has been shown to correlate with cardiovascular magnetic resonance (CMR) derived RV indices. However, the prognostic role of RVIP-LGE and other CMR-derived parameters of RV function are not well established. Our aim was to evaluate the predictive value of contrast-enhanced CMR in patients with PH., Methods: RV size, ejection fraction (RVEF), and the presence of RVIP-LGE were determined in 58 patients with PH referred for CMR. All patients underwent right heart catheterization, exercise testing, and N-terminal pro-brain natriuretic peptide (NT-proBNP) evaluation; results of which were included in the final analysis if performed within 4 months of the CMR study. Patients were followed for the primary endpoint of time to clinical worsening (death, decompensated right ventricular heart failure, initiation of prostacyclin, or lung transplantation)., Results: Overall, 40/58 (69%) of patients had RVIP-LGE. Patients with RVIP- LGE had larger right ventricular volume index, lower RVEF, and higher mean pulmonary artery pressure (mPAP), all p < 0.05. During the follow-up period of 10.2 ± 6.3 months, 19 patients reached the primary endpoint. In a univariate analysis, RVIP-LGE was a predictor for adverse outcomes (p = 0.026). In a multivariate analysis, CMR-derived RVEF was an independent predictor of clinical worsening (p = 0.036) along with well-established prognostic parameters such as exercise capacity (p = 0.010) and mPAP (p = 0.001)., Conclusions: The presence of RVIP-LGE in patients with PH is a marker for more advanced disease and poor prognosis. In addition, this study reveals for the first time that CMR-derived RVEF is an independent non-invasive imaging predictor of adverse outcomes in this patient population., (© 2012 Freed et al; licensee BioMed Central Ltd.)
- Published
- 2012
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