Prognostic Value of Left Ventricular Function and Mechanics in Pulmonary Hypertension: A Pilot Cardiovascular Magnetic Resonance Feature Tracking Study.

Lina Padervinskienė,Irena Nedzelskienė,Aušra Krivickienė,Skaidrius Miliauskas,Antanas Jankauskas,Algidas Basevičius,Deimantė Hoppenot,Paulius Šimkus,Eglė Ereminienė

doi:10.3390/medicina55030073

Lina Padervinskienė, Irena Nedzelskienė + Show 7 more

Open Access

https://doi.org/10.3390/medicina55030073

Copy DOI

Abstract

Background and objective: Cardiovascular magnetic resonance (CMR) - based feature tracking (FT) can detect left ventricular (LV) strain abnormalities in pulmonary hypertension (PH) patients, but little is known about the prognostic value of LV function and mechanics in PH patients. The aim of this study was to evaluate LV systolic function by conventional CMR and LV global strains by CMR-based FT analysis in precapillary PH patients, thereby defining the prognostic value of LV function and mechanics. Methods: We prospectively enrolled 43 patients with precapillary PH (mean pulmonary artery pressure (mPAP) 55.91 ± 15.87 mmHg, pulmonary arterial wedge pressure (PAWP) ≤15 mmHg) referred to CMR for PH evaluation. Using FT software, the LV global longitudinal strain (GLS) and global circumferential strain (GCS), also right ventricular (RV) GLS were analyzed. Results: Patients were classified into two groups according to survival (survival/non-survival). LV GLS was significantly reduced in the non-survival group (−12.4% [−19.0–(−7.8)] vs. −18.4% [−22.5–(−15.5)], p = 0.009). By ROC curve analysis, LV GLS > −14.2% (CI: 3.229 to 37.301, p < 0.001) was found to be robust predictor of mortality in PH patients. Univariable analysis using the Cox model showed that severely reduced LV GLS > −14.2%, with good sensitivity (77.8%) and high specificity (93.5%) indicated an increase of the risk of death by 11-fold. LV GLS significantly correlated in PH patients with RV ESVI (r = 0.322, p = 0.035), RV EF (r = 0.444, p < 0.003). Conclusions: LV systolic function and LV global longitudinal strain measurements using CMR-FT correlates with RV dysfunction and is associated with poor clinical outcomes in precapillary PH patients.

Highlights

Pulmonary hypertension (PH) is defined as an increase in mean pulmonary artery pressure >25 mmHg evaluated by right heart catheterisation (RHC) [1]
Baggen VJM et al in their systematic review and meta-analysis concluded that right ventricular ejection fraction, right ventricular end-diastolic and end-systolic volumes indices, and left ventricular end-diastolic volume index were of prognostic importance [26] in pulmonary hypertension (PH) patients
We demonstrated that the left ventricular global longitudinal strain was significantly reduced in non-survival PH patients compared to patient which survived

Summary

Introduction

Pulmonary hypertension (PH) is defined as an increase in mean pulmonary artery pressure (mPAP) >25 mmHg evaluated by right heart catheterisation (RHC) [1]. Over time, increased pulmonary artery pressure eventually causes vascular remodeling and right ventricular (RV) dysfunction. Cardiovascular magnetic resonance (CMR) - based feature tracking (FT) can detect left ventricular (LV) strain abnormalities in pulmonary hypertension (PH) patients, but little is known about the prognostic value of LV function and mechanics in PH patients. The aim of this study was to evaluate LV systolic function by conventional CMR and LV global strains by CMR-based FT analysis in precapillary PH patients, thereby defining the prognostic value of LV function and mechanics. LV GLS was significantly reduced in the non-survival group (−12.4% [−19.0–(−7.8)] vs −18.4% [−22.5–(−15.5)], p = 0.009). Univariable analysis using the Cox model showed that severely reduced LV GLS > −14.2%, with good sensitivity (77.8%) and high specificity (93.5%)

Objectives

Methods

Results

Discussion

Conclusion