Abstract
In this prospective pilot study, we aimed to evaluate the ability of cardiac magnetic resonance imaging (CMR) parameters of right ventricular function and pulmonary artery stiffness to identify pulmonary hypertension (PH), predict major adverse cardiovascular events (MACEs) in patients with secondary PH due to chronic obstructive pulmonary disease (COPD), and to estimate a prospective sample size necessary for a reliable power of the study. Thirty consecutive patients with COPD and suspected secondary PH were assessed by clinical examination, the six minute walk test, echocardiography, right heart catheterization and CMR, and followed–up for a mean period of 16 months to identify MACEs (cardiac death, ventricular tachyarrhythmia, and heart failure). Among CMR parameters of pulmonary artery stiffness, pulse wave velocity (PWV) yielded the best sensitivity (93.5%) and specificity (92.8%) for identifying PH, as diagnosed by cardiac catheterization. Moreover, PWV proved to be a valuable predictor of MACEs (HR = 4.75, 95% CI 1.00 to 22.59, p = 0.03). In conclusion, PWV by phase-contrast CMR can accurately identify PH in patients with COPD and may help stratify prognosis.
Highlights
Lucia Agoston-Coldea[1], Silvia Lupu 2 & Teodora Mocan[3]. In this prospective pilot study, we aimed to evaluate the ability of cardiac magnetic resonance imaging (CMR) parameters of right ventricular function and pulmonary artery stiffness to identify pulmonary hypertension (PH), predict major adverse cardiovascular events (MACEs) in patients with secondary PH due to chronic obstructive pulmonary disease (COPD), and to estimate a prospective sample size necessary for a reliable power of the study
Increased pulmonary artery (PA) stiffness is associated with elevated afterload, exerting stress on the right ventricular (RV) which first adapts by hypertrophy, dilates, resulting in right heart failure[12]
Patients were included in the study provided they fulfilled the following criteria: (1) confirmed diagnosis of COPD, according to the criteria of the Global Initiative for Chronic Obstructive Lung Disease[20]; (2) confirmed diagnosis of acute exacerbation defined as aggravated dyspnoea, cough, or sputum production warranting a change in therapy; 3) high probability of PH by echocardiographic criteria; 4) absence of other factors that might have induced PH
Summary
In this prospective pilot study, we aimed to evaluate the ability of cardiac magnetic resonance imaging (CMR) parameters of right ventricular function and pulmonary artery stiffness to identify pulmonary hypertension (PH), predict major adverse cardiovascular events (MACEs) in patients with secondary PH due to chronic obstructive pulmonary disease (COPD), and to estimate a prospective sample size necessary for a reliable power of the study. Echocardiography can only be used for assessing the probability of PH, and studies that would endorse the use of CMR alone are still scarce On these considerations, we aimed to conduct a prospective study that allowed us to evaluate RV function and relationship between PA stiffness indices using CMR and adverse long-term outcome in patients with COPD and suspected secondary PH
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