Open AccessDobutamine stress MRI in pulmonary hypertension: relationships between stress pulmonary artery relative area change, RV performance, and 10‐year survival
Author(s) -
Blyth Kevin G.,
Bellofiore Alessandro,
Jayasekera Geeshath,
Foster John E.,
Steedman Tracey,
Chesler Naomi C.,
Peacock Andrew J.
Publication year - 2017
Publication title -
pulmonary circulation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.791
H-Index - 40
ISSN - 2045-8940
DOI - 10.1177/2045893217704838
Subject(s) - medicine , cardiology , pulmonary artery , magnetic resonance imaging , dobutamine , stroke volume , pulmonary hypertension , hemodynamics , heart failure , radiology , ejection fraction
In pulmonary hypertension (PH), right ventricular (RV) performance determines survival. Pulmonary artery (PA) stiffening is an important biomechanical event in PH and also predicts survival based on the PA relative area change (RAC) measured at rest using magnetic resonance imaging (MRI). In this exploratory study, we sought to generate novel hypotheses regarding the influence of stress RAC on PH prognosis and the interaction between PA stiffening, RV performance and survival. Fifteen PH patients underwent dobutamine stress‐MRI (ds‐MRI) and right heart catheterization. RAC REST , RAC STRESS , and ΔRAC (RAC STRESS – RAC REST ) were correlated against resting invasive hemodynamics and ds‐MRI data regarding RV performance and RV‐PA coupling efficiency (n’ vv [RV stroke volume/RV end‐systolic volume]). The impact of RAC, RV data, and n’ vv on ten‐year survival were determined using Kaplan–Meier analysis. PH patients with a low ΔRAC (<−2.6%) had a worse long‐term survival (log‐rank P = 0.045, HR for death = 4.46 [95% CI = 1.08–24.5]) than those with ΔRAC ≥ −2.6%. Given the small sample, these data should be interpreted with caution; however, low ΔRAC was associated with an increase in stress diastolic PA area indicating proximal PA stiffening. Associations of borderline significance were observed between low RAC STRESS and low n’ vvSTRESS , Δη’ VV , and ΔRVEF. Further studies are required to validate the potential prognostic impact of ΔRAC and the biomechanics potentially connecting low ΔRAC to shorter survival. Such studies may facilitate development of novel PH therapies targeted to the proximal PA.