Abstract
BackgroundPrevious work indicates that dilatation of the pulmonary artery (PA) itself or in relation to the ascending aorta (PA:Ao ratio) predicts pulmonary hypertension (PH). Whether these results also apply for heart failure with preserved ejection fraction (HFpEF) is unknown.In the present study we evaluated the diagnostic and prognostic power of PA diameter and PA:Ao ratio on top of right ventricular (RV) size, function, and septomarginal trabeculation (SMT) thickness by cardiovascular magnetic resonance (CMR) in HFpEF.Methods and Results159 consecutive HFpEF patients were prospectively enrolled. Of these, 111 underwent CMR and invasive hemodynamic evaluation.By invasive assessment 64 % of patients suffered from moderate/severe PH (mean pulmonary artery pressure (mPAP) ≥30 mmHg). Significant differences between groups with and without moderate/severe PH were observed with respect to PA diameter (30.9 ± 5.1 mm versus 26 ± 5.1 mm, p < 0.001), PA:Ao ratio (0.93 ± 0.16 versus 0.78 ± 0.14, p < 0.001), and SMT diameter (4.6 ± 1.5 mm versus 3.8 ± 1.2 mm; p = 0.008). The strongest correlation with mPAP was found for PA:Ao ratio (r = 0.421, p < 0.001). By ROC analysis the best cut-off for the detection of moderate/severe PH was found for a PA:Ao ratio of 0.83.Patients were followed for 22.0 ± 14.9 months. By Kaplan Meier analysis event-free survival was significantly worse in patients with a PA:Ao ratio ≥0.83 (log rank, p = 0.004). By multivariable Cox-regression analysis PA:Ao ratio was independently associated with event-free survival (p = 0.003).ConclusionPA:Ao ratio is an easily measureable noninvasive indicator for the presence and severity of PH in HFpEF, and it is related with outcome.
Highlights
Previous work indicates that dilatation of the pulmonary artery (PA) itself or in relation to the ascending aorta (PA:Ao ratio) predicts pulmonary hypertension (PH)
With respect to baseline clinical parameters, patients with moderate/severe PH more frequently presented with diabetes (50.0 % versus 23.1 %, p = 0.006), non-significant coronary artery disease/previous revascularization (27.1 % versus 5.1 %, p = 0.005); shorter 6-min walk distances (301 ± 110 m versus 397 ± 104 m, p < 0.001) and had more dilated left atria (LA; 66.7 ± 9.3 mm versus 62.9 ± 8.7 mm, p = 0.035 for diameters and 33.5 ± 10.2 cm2 versus 28.3 ± 6.8 cm2, p = 0.005 for areas)
Invasive assessment showed significant differences between patients with and without moderate/severe PH with respect to all measured variables except for cardiac output (CO), which was similar in both groups (5.2 ± 1.2 versus 5.2 ± 1.5 l/min, p = 0.829)
Summary
Previous work indicates that dilatation of the pulmonary artery (PA) itself or in relation to the ascending aorta (PA:Ao ratio) predicts pulmonary hypertension (PH). Whether these results apply for heart failure with preserved ejection fraction (HFpEF) is unknown. About 50 % of patients presenting with symptoms of heart failure are diagnosed with heart failure with preserved ejection fraction (HFpEF). Because of the invasive nature of this procedure the majority of HFpEF patients today are not evaluated by right heart catheter (RHC). An alternative straightforward non-invasive technique in addition to echocardiography is desirable to predict the likelihood of PH in HFpEF patients
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