Abstract
BackgroundNo unified method exists to effectively predict and monitor progression of pulmonary arterial hypertension (PAH). We assessed the longitudinal relationship between a novel marker of cardiopulmonary reserve and established prognostic surrogate markers in patients with pulmonary vascular disease.Methods and ResultsTwenty participants with confirmed (n = 14) or at high risk (n = 6) for PAH underwent cardiovascular magnetic resonance (CMR) at baseline and after ~6 months of guideline-appropriate management. Ten PAH participants underwent RHC within 48 h of each CMR. RHC (mean pulmonary arterial pressure, mPAP; pulmonary vascular resistance index, PVRI; cardiac index, CI) and phase-contrast CMR (mean pulmonary arterial blood flow velocity, meanPAvel) measurements were taken at rest and during continuous adenosine infusion (70/140/210 mcg/kg/min). Initial meanPAvel’s (rest and hyperemic) were correlated with validated surrogate prognostic parameters (CMR: RV ejection fraction, RVEF; RV end systolic volume indexed, RVESVI; RHC: PVRI, CI; biomarker: NT-pro brain natriuretic peptide, NTpBNP; clinical: 6-min walk distance, 6MWD), a measure of pulmonary arterial stiffness (elastic modulus) and volumetric estimation of RV ventriculoarterial (VA) coupling. Changes in meanPAvel’s were correlated with changes in comparator parameters over time.At initial assessment, meanPAvel at rest correlated significantly with PVRI (inversely), CI (positively) and elastic modulus (inversely) (R2 > 0.37,P < 0.05 for all), whereas meanPAvel at peak hyperemia correlated significantly with PVRI, RVEF, RVESVI, 6MWD, elastic modulus and VA coupling (R2 > 0.30,P < 0.05 for all). Neither resting or hyperemia-derived meanPAvel correlated with NTpBNP levels. Initial meanPAvel at rest correlated significantly with RVEF, RVESVI, CI and VA coupling at follow up assessment (R2 > 0.2,P < 0.05 for all) and initial meanPAvel at peak hyperemia correlated with RVEF, RVESVI, PVRI and VA coupling (R2 > 0.37,P < 0.05 for all). Change in meanPAvel at rest over time did not show statistically significant correlation with change in prognostic parameters, while change in meanPAvel at peak hyperemia did show a significant relationship with ΔRVEF, ΔRVESVI, ΔNTpBNP and ΔCI (R2 > 0.24,P < 0.05 for all).ConclusionMeanPAvel during peak hyperemia correlated with invasive, non-invasive and clinical prognostic parameters at different time points. Further studies with predefined clinical endpoints are required to evaluated if this novel tool is a marker of disease progression in patients with pulmonary vascular disease.
Highlights
No unified method exists to effectively predict and monitor progression of pulmonary arterial hypertension (PAH)
We previously demonstrated proof-of-concept for a novel non-invasive method to assess ‘cardiopulmonary reserve’ as it pertains to PAH by measuring the average pulmonary arterial blood flow velocity at rest and during standardised intravenous (IV) adenosine infusion using phase-contrast cardiovascular magnetic resonance (CMR) [1]
As a marker of cardiopulmonary reserve and with the advantage of ameliorating the impact of unrelated systemic processes on variables measured at rest, we hypothesised that meanPAvel at peak hyperemia may provide prognostic information at initial assessment and during follow up
Summary
No unified method exists to effectively predict and monitor progression of pulmonary arterial hypertension (PAH). We previously demonstrated proof-of-concept for a novel non-invasive method to assess ‘cardiopulmonary reserve’ as it pertains to PAH by measuring the average pulmonary arterial blood flow velocity (meanPAvel) at rest and during standardised intravenous (IV) adenosine infusion using phase-contrast cardiovascular magnetic resonance (CMR) [1]. This approach to ‘stressing’ the cardiopulmonary unit, whilst novel, was feasible, safe and simple, with the results confirming that meanPAvel at peak hyperemia was an excellent functional correlate for cardiopulmonary reserve across a range of clinical risk phenotypes. We hypothesised that relative to meanPAvel at rest, meanPAvel at peak hyperaemia at initial assessment would be more closely associated with comparator parameters at initial and follow-up assessments, and that changes in meanPAvel at peak hyperemia would correlate more closely with changes in these prognostic markers over time
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