Julia Grapsa1, Timothy C Tan2, Maria Carmo Pereira Nunes2, Declan P O'Regan3, Giuliana Durighel3, Luke S G E Howard4, J Simon R Gibbs4, Petros Nihoyannopoulos5. 1. Department of Cardiovascular Sciences, Bart's Health Trust, London, United Kingdom. Electronic address: Julia.grapsa@nhs.net. 2. Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America. 3. Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College, Hammersmith Hospital Campus, United Kingdom. 4. National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College London, United Kingdom. 5. Department of Cardiovascular Sciences, Hammersmith Hospital, Imperial College London, United Kingdom.
Abstract
BACKGROUND: Compensatory remodelling i.e. increased right ventricular (RV) mass frequently occurs as an adaptive response to the chronic pressure overload to maintain contractile function. The prognostic value of the serial change in RV mass is unclear. AIM: The aim of our study was to examine the longitudinal changes in RV mass and survival in patients with idiopathic pulmonary arterial hypertension (IPAH). METHODS: Consecutive newly diagnosed IPAH patients >18 years old were prospectively recruited from a tertiary referral center. All recruited patients were maintained on guideline-based therapy and were followed up with echocardiography and cardiac magnetic resonance for 2 years. RESULTS: Serial measures of RV mass revealed that survivors appeared to have had a compensatory increase in RV mass, which constituted adaptive RV remodelling early in the disease process, which was not seen in those who died. (Hazard ratio of 0.932, 95% confidence interval 0.893-0.973, p = 0.001). CONCLUSION: This study shows that serial measurement of RV mass in IPAH patients provides prognostic information. RV mass regression is an ominous prognostic sign, which may predict early mortality in these patients.
BACKGROUND: Compensatory remodelling i.e. increased right ventricular (RV) mass frequently occurs as an adaptive response to the chronic pressure overload to maintain contractile function. The prognostic value of the serial change in RV mass is unclear. AIM: The aim of our study was to examine the longitudinal changes in RV mass and survival in patients with idiopathic pulmonary arterial hypertension (IPAH). METHODS: Consecutive newly diagnosed IPAHpatients >18 years old were prospectively recruited from a tertiary referral center. All recruited patients were maintained on guideline-based therapy and were followed up with echocardiography and cardiac magnetic resonance for 2 years. RESULTS: Serial measures of RV mass revealed that survivors appeared to have had a compensatory increase in RV mass, which constituted adaptive RV remodelling early in the disease process, which was not seen in those who died. (Hazard ratio of 0.932, 95% confidence interval 0.893-0.973, p = 0.001). CONCLUSION: This study shows that serial measurement of RV mass in IPAHpatients provides prognostic information. RV mass regression is an ominous prognostic sign, which may predict early mortality in these patients.
Authors: Ze Ming Goh; Nithin Balasubramanian; Samer Alabed; Krit Dwivedi; Yousef Shahin; Alexander M K Rothman; Pankaj Garg; Allan Lawrie; David Capener; A A Roger Thompson; Faisal Alandejani; Jim M Wild; Christopher S Johns; Robert A Lewis; Rebecca Gosling; Michael Sharkey; Robin Condliffe; David G Kiely; Andrew J Swift Journal: Heart Date: 2022-08-11 Impact factor: 7.365