Towards the implementation of optimal cardiac magnetic resonance risk stratification in PAH

Chest. 2023 Jul 30:S0012-3692(23)01066-8. doi: 10.1016/j.chest.2023.07.028. Online ahead of print.ABSTRACTBACKGROUND: The 2022 European pulmonary hypertension (PH) guidelines incorporate cardiac magnetic resonance (CMR) imaging metrics in the risk stratification of pulmonary arterial hypertension (PAH) patients. Thresholds to identify patients at estimated 1-year mortality risks of <5%, 5-20% and >20% are introduced. However, these cut-off values are mostly single center based and require external validation.RESEARCH QUESTIONS: What are the discriminative prognostic properties of the current cardiac magnetic resonance thresholds in risk stratifying pulmonary arterial hypertension patients?METHODS: We analyzed data from incident, treatment naïve PAH patients from the Amsterdam University Medical Centres, VUmc, the Netherlands. The discriminative properties of the proposed CMR three risk stratum was tested at baseline and first reassessment, using the following PH guideline variables: right ventricular ejection fraction (RVEF), indexed right ventricular end systolic volume (RVESVi) and indexed left ventricular stroke volume (SVi).RESULTS: 258 PAH patients diagnosed between 2001 and 2022 fulfilled the study criteria and were included in the present study. Of these, 172 had a follow-up CMR after 3 months - 1.5 years. According to the CMR three risk stratum, most patients were classified at intermediate risk 45% (n=115) upon diagnosis. Only 11% (n=29) of PAH patients were c...
Source: Chest - Category: Respiratory Medicine Authors: Source Type: research