Increased right atrial volume measured with cardiac magnetic resonance is associated with worse clinical outcome in patients with pre-capillary pulmonary hypertension

Anna Bredfelt; Göran Rådegran; Roger Hesselstrand; Håkan Arheden; Ellen Ostenfeld

doi:10.1002/ehf2.12304

Increased right atrial volume measured with cardiac magnetic resonance is associated with worse clinical outcome in patients with pre-capillary pulmonary hypertension

ESC Heart Fail. 2018 Oct;5(5):864-875. doi: 10.1002/ehf2.12304. Epub 2018 Jun 19.

Authors

Anna Bredfelt^{1

2}, Göran Rådegran^{3

4}, Roger Hesselstrand^{5

6}, Håkan Arheden^{1

2}, Ellen Ostenfeld^{1

2}

Affiliations

¹ Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Lund, Sweden.
² Department of Clinical Physiology and Nuclear Imaging, Skåne University Hospital, Getingevägen 5, SE-22185, Lund, Sweden.
³ Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden.
⁴ The Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skåne University Hospital, Lund, Sweden.
⁵ Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden.
⁶ Skåne University Hospital, Lund, Sweden.

Abstract

Aims: Pre-capillary pulmonary hypertension (PH_pre-cap ) has a poor prognosis, especially when caused by pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SSc-PAH). Whether cardiac magnetic resonance (CMR)-based quantification of atrial volumes in PH_pre-cap is beneficial in risk assessment is unknown. The aims were to investigate if (i) atrial volumes using CMR are associated with death or lung transplantation in PH_pre-cap , (ii) atrial volumes differ among four unmatched major PH_pre-cap subgroups, and (iii) atrial volumes differ between SSc-PAH and idiopathic/familial PAH (IPAH/FPAH) when matched for pulmonary vascular resistance (PVR).

Methods and results: Seventy-five PH_pre-cap patients (57 ± 19 years, 53 female, 43 de novo) with CMR and right heart catheterization were retrospectively included. Short-axis stacks of cine images were analysed, and right and left atrial maximum (RAV_max and LAV_max ) and minimum volume (RAV_min and LAV_min ) were indexed for body surface area. Increased (mean + 2 SD) and reduced (mean - 2 SD) volumes were predefined from CMR normal values. Transplantation-free survival was lower in patients with increased RAV_max than in those with normal [hazard ratio (HR) = 2.1, 95% confidence interval (CI) 1.1-4.0] but did not differ between those with reduced LAV_max and normal (HR 2.0, 95% CI 0.8-5.1). RAV_max and RAV_min showed no differences among unmatched or matched groups (P = ns). When matched for PVR, LAV_max , LAV_min , and pulmonary artery wedge pressure were reduced in SSc-PAH compared with IPAH/FPAH (95% CI 0.3-21.4, 95% CI 0.8-19.6, and 95% CI 2-7, respectively).

Conclusions: Patients with PH_pre-cap and increased right atrial volume measured with CMR had worse clinical outcome. When matched for PVR, left atrial volume was lower in SSc-PAH than in IPAH/FPAH, consistent with left-sided underfilling, indicating a potential differentiator between the groups.

Keywords: Cardiac magnetic resonance imaging; Left atrial volume; Pulmonary hypertension; Right atrial volume; Transplantation-free survival.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Capillaries / physiopathology
Cardiac Volume / physiology*
Disease Progression
Female
Heart Atria / diagnostic imaging*
Heart Atria / physiopathology
Humans
Hypertension, Pulmonary / diagnosis*
Hypertension, Pulmonary / physiopathology
Magnetic Resonance Imaging, Cine / methods*
Male
Middle Aged
Prognosis
Pulmonary Wedge Pressure / physiology*
Retrospective Studies
Severity of Illness Index
Vascular Resistance / physiology*