Author + information
- Siva Kumar Soma,
- Dilip Raghuveer,
- Sourabh Prabhakar,
- June Yamrozik,
- Ronald Williams,
- Diane Vido,
- Mark Doyle,
- Raymond Benza,
- Srinivas Murali,
- Amresh Raina and
- Robert Biederman
Right ventricular (RV) function predicts prognosis in pulmonary arterial hypertension (PAH) patients (pts) and right ventricular (RV) failure. Prior studies evaluating of 3D RV ejection fraction (EF) have yielded inconsistent prognostic information. Here we explore the prognostic value of contrast enhanced Cardiac MRI (CMR) in PAH (WHO group 1) pts. We hypothesize that CMR-Late Gadolinium Enhancement (LGE), a marker for myocardial fibrosis, when present in RV or RV insertion points (RVIP), provides additional prognostic information.
A retrospective chart review of PAH pts (n=46) who underwent CMR were analyzed. Demographic data: age: 56±5 yrs; 80% female. RV volumetric data from MRI included RVEF, RVESVI, RVEDVI and RVMI. RVIP LGE was classified as LGE + or LGE-. These were correlated with major adverse clinical events (MACE) including death, hospitalization, referral/need for lung transplant and addition of inhaled/IV prostacyclin therapy.
LGE was positive (+) in 26 pts (57%) and negative (−) in 20 pts (43%). There were 29 MACE events in LGE+ group (avg 1.1 ± 1.5) and 8 MACE events in LGE- group (avg 0.4 ± 0.6) (p<0.05). The predominant MACE events (78%), hospitalizations (77%) and addition of prostacyclin therapy (100%) occurred in the LGE+ group (p<0.05). LGE + correlated with addition of prostacyclin drugs (Fisher's exact test = 0.03). Events in LGE+ group included 20 hospitalizations, 4 deaths, 2 lung transplant referrals and addition of prostacyclin therapy in 6 patients. LGE- group had only 6 hospitalizations, 4 deaths and no other events. Among CMR metrics, only decreasing RVEF and increasing RVEDVI predicted hospitalization. LGE provided incremental value in predicting hospitalization with RVEDVI.
Late Gadolinium Enhancement is a significant predictor of MACE events including hospitalization and addition of prostacyclin therapy. LGE+ has incremental value in predicting hospitalizations along with RVEDVI. However, LGE status alone provides additional prognostic information to standard CMR metrics and hemodynamic data in MACE. LGE may reflect the pathophysiologic hallmark in PH patients of progressive myocardial fibrosis and RV failure.
West, Room 3002
Sunday, March 10, 2013, 8:15 a.m.-8:30 a.m.
Session Title: Pulmonary Hypertension
Abstract Category: 27. Pulmonary Hypertension
Presentation Number: 917-4
- 2013 American College of Cardiology Foundation