Relationship between right atrium area and right ventricular ejection fraction on magnetic resonance imaging: comparison with other prognostic markers in patients with pulmonary arterial hypertension

Abstract

Objective: To compare the right atrium (RA) area and right ventricular ejection fraction (RVEF) with other known prognostic markers in patients with pulmonary arterial hypertension (PAH). Materials and Methods: This was a retrospective study of 74 patients diagnosed with PAH by right heart catheterization at a referral center between January 2018 and May 2018. All of the patients underwent cardiac magnetic resonance imaging (MRI) within 3 months of the right heart catheterization (RHC), as well as undergoing echocardiography, a 6-minute walk test, and determination of the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) within a month of the RHC. We attempted to determine whether the cardiac MRI-derived RA area correlated with ions between RVEF and RA area measured by that determined by echocardiography, as well as whether the cardiac MRI-derived RA area and RVEF correlated with the 6-minute walk distance and NT-proBNP level. Results: The MRI-derived RA area demonstrated a weak correlation with the pulmonary vascular resistance measured by RHC (r = 0.268; p = 0.055) and a moderate correlation with the NT-proBNP (r = 0.429; p = 0.003). All correlations between clinical characteristics and the RVEF were statistically significant. In the univariate linear analysis, the RVEF showed stronger correlations with the clinical characteristics than did the RA area. Conclusion: In patients with PAH, cardiac MRI-derived RVEF appears to correlate more strongly with other prognostic factors than does RA area.

Cardiac biomarkers as indicators of right ventricular dysfunction and recovery in chronic thromboembolic pulmonary hypertension patients after balloon pulmonary angioplasty therapy – a cardiac magnetic resonance imaging cohort study

“…Circulating levels of natriuretic peptides mirror myocardial stress due to pressure and volume overload and are established diagnostic and prognostic markers in heart failure 29 12 associated with secondary right heart failure and assessment of these biomarkers is recommended for screening, individual risk stratification, and therapy monitoring 30 . The current study found a strong correlation of NT-proBNP with right ventricular dimensions and function prior to BPA therapy, which is in line with the findings from other series 26,31 . The current guidelines on PH suggest an NT-proBNP level >300 ng/L as a cut-off to distinguish low-risk and elevated-risk patients 30 .…”

“…29 The current study found a strong correlation of NT-proBNP with right ventricular dimensions and function prior to BPA therapy, which is in line with the findings from other series. 25,30 The current guidelines on PH suggest an NT-proBNP level >300 ng/L as a cut-off to distinguish low-risk and elevated-risk patients. 29 Consistent with this, patients in our cohort with a severely impaired RVEF were identified by an NT-proBNP level !347 ng/L and showed a median level of 1427 ng/L at baseline, whereas patients with an RVEF > 35% had a median level of 214 ng/L.…”

“…Biomarker levels were compared with findings for right heart morphology and function derived from CMR. RESULTS: Pulmonary hemodynamics improved after BPA therapy [PVR: 7.7 (6.0-9.0) vs. 4.7 (3.5-5.5) WU, p<0.001; meanPAP 41 (38)(39)(40)(41)(42)(43)(44)(45)(46)(47) vs. 32 (28)(29)(30)(31)(32)(33)(34)(35)(36)(37) Chronic thromboembolic pulmonary hypertension (CTEPH) is diagnosed in about 3% of patients who survive an acute pulmonary embolism 1 . Progressive impairment of pulmonary hemodynamics burdens the right heart and causes maladaptive morphological and functional right heart remodeling 2 .…”

Cardiac magnetic resonance imaging and clinical prognosis in pulmonary arterial hypertension

“…In this issue of Radiologia Brasileira, readers will find an interesting article authored by Mello et al (9) , who studied the relationship between the right atrium area and the RV ejection fraction by MRI, in comparison with other prognostic markers, in patients with PAH. In their study, the authors found that the RV ejection fraction and the right atrium area determined by cardiac MRI both correlated with clinical prognostic markers.…”