TY - JOUR
T1 - Right atrial emptying fraction non-invasively predicts mortality in pulmonary hypertension
AU - Darsaklis, Konstadina
AU - Dickson, Matthew E.
AU - Cornwell, William
AU - Ayers, Colby R.
AU - Torres, Fernando
AU - Chin, Kelly M.
AU - Matulevicius, Susan
N1 - Funding Information:
M.D., K.D., W.C.: None. K.C.: Research grants from Actelion, Bayer, Geon, Gilead, GlaxoSmithKline, NIH, Novartis, United Therapeutics; honoraria from Actelion, Bayer, Gilead. F.T.: Research grants from Akaria, Bayer, Geon, Gilead, Medtronic; consultant/advisory board with Actelion, Bayer, Gilead, LungLLC, Novartis, United Therapeutics. S.M.: Research grants from ACC/GE Healthcare Career Development Award, National Center for Advancing Translational Sciences, NIH, UT-STAR.
Publisher Copyright:
© 2016, Springer Science+Business Media Dordrecht.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Right-sided heart failure is the most common cause of death in pulmonary hypertension (PH). Echocardiographic measurements of right atrial (RA) size are associated with worse outcome in PH, however the association between RA function and death in PH has not been well-described. 160 PH patients (World Health Organization groups 1–5) underwent cardiac magnetic resonance imaging (cMRI) and right heart catheterization (RHC) within 6 weeks of each other at a tertiary care academic medical center in the United States. We measured cMRI RA maximum and minimum volumes indexed to body surface area and calculated RA emptying fraction (RAEF). We evaluated the relationship between RAEF and clinical variables with death using Cox proportional hazard models. 57 deaths occurred during a median follow-up of 3.5 years (36 % died overall, 10 % per year). RAEF was directly correlated in univariate analyses with right ventricular (RV) ejection fraction, left ventricular (LV) ejection fraction, LV size, cardiac index, absence of tricuspid and pulmonic regurgitation, absence of pericardial effusion, estimated glomerular filtration rate, 6-minute walk distance, and pulmonary arterial oxygen saturation, whereas it was inversely correlated with death, BNP, heart rate, mean RA pressure, mean PA pressure, pulmonary and systemic vascular resistance, RV size, and RA size. Using multivariate analyses, RAEF had a robust inverse association with death after adjusting for measured risk factors (HR per 5 % change in RAEF: 0.83 [95 % CI 0.73–0.94], p = 0.003). In PH patients, decreased RAEF by cMRI is independently associated with worse survival after adjustment for other risk factors.
AB - Right-sided heart failure is the most common cause of death in pulmonary hypertension (PH). Echocardiographic measurements of right atrial (RA) size are associated with worse outcome in PH, however the association between RA function and death in PH has not been well-described. 160 PH patients (World Health Organization groups 1–5) underwent cardiac magnetic resonance imaging (cMRI) and right heart catheterization (RHC) within 6 weeks of each other at a tertiary care academic medical center in the United States. We measured cMRI RA maximum and minimum volumes indexed to body surface area and calculated RA emptying fraction (RAEF). We evaluated the relationship between RAEF and clinical variables with death using Cox proportional hazard models. 57 deaths occurred during a median follow-up of 3.5 years (36 % died overall, 10 % per year). RAEF was directly correlated in univariate analyses with right ventricular (RV) ejection fraction, left ventricular (LV) ejection fraction, LV size, cardiac index, absence of tricuspid and pulmonic regurgitation, absence of pericardial effusion, estimated glomerular filtration rate, 6-minute walk distance, and pulmonary arterial oxygen saturation, whereas it was inversely correlated with death, BNP, heart rate, mean RA pressure, mean PA pressure, pulmonary and systemic vascular resistance, RV size, and RA size. Using multivariate analyses, RAEF had a robust inverse association with death after adjusting for measured risk factors (HR per 5 % change in RAEF: 0.83 [95 % CI 0.73–0.94], p = 0.003). In PH patients, decreased RAEF by cMRI is independently associated with worse survival after adjustment for other risk factors.
KW - Atrium
KW - Magnetic resonance imaging
KW - Pulmonary heart disease
KW - Right heart failure
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U2 - 10.1007/s10554-016-0883-3
DO - 10.1007/s10554-016-0883-3
M3 - Article
C2 - 27076226
AN - SCOPUS:84963700617
SN - 1569-5794
VL - 32
SP - 1121
EP - 1130
JO - International Journal of Cardiovascular Imaging
JF - International Journal of Cardiovascular Imaging
IS - 7
ER -