In pulmonary arterial hypertension (PAH) increased afterload leads to adaptive processes of the right ventricle (RV) that help to maintain arterio-ventricular coupling of RV and preserve cardiac output, but with time the adaptive mechanisms fail. In this study, we propose a multimodal approach which allows to estimate prognostic value of RV coupling parameters in PAH patients. Twenty-seven stable PAH patients (49.5 ± 15.5 years) and 12 controls underwent cardiovascular magnetic resonance (CMR). CMR feature tracking analysis was performed for RV global longitudinal strain assessment (RV GLS). RV-arterial coupling was evaluated by combination of RV GLS and three proposed surrogates of RV afterload—pulmonary artery systolic pressure (PASP), pulmonary vascular resistance (PVR) and pulmonary artery compliance (PAC). 18-FDG positron emission tomography (PET) analysis was used to assess RV glucose uptake presented as SUVRV/LV. Follow-up time of this study was 25 months and the clinical end-point was defined as death or clinical deterioration. Coupling parameters (RV GLS/PASP, RV GLS/PVR and RV GLS*PAC) significantly correlated with RV function and standardized uptake value (SUVRV/LV). Patients who experienced a clinical end-point (n = 18) had a significantly worse coupling parameters at the baseline visit. RV GLS/PASP had the highest area under curve in predicting a clinical end-point and patients with a value higher than (−)0.29%/mmHg had significantly worse prognosis. It was also a statistically significant predictor of clinical end-point in multivariate analysis (adjusted R2 = 0.68; p < 0.001). Coupling parameters are linked with RV hemodynamics and glucose metabolism in PAH. Combining CMR and hemodynamic measurements offers more comprehensive assessment of RV function required for prognostication of PAH patients. Trial Registration: NCT03688698, 09/26/2018, retrospectively registered; Protocol ID: 2017/25/N/NZ5/02689

中文翻译：

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肺动脉高压右心室超负荷代谢和临床后果的多模式评估


在肺动脉高压 (PAH) 中，后负荷增加会导致右心室 (RV) 的适应性过程，有助于维持 RV 的动-心室耦合并保持心输出量，但随着时间的推移，适应性机制会失效。在这项研究中，我们提出了一种多模式方法，可以估计 RV 耦合参数对 PAH 患者的预后价值。 27 名稳定 PAH 患者（49.5 ± 15.5 岁）和 12 名对照者接受了心血管磁共振 (CMR)。对 RV 全局纵向应变评估 (RV GLS) 进行 CMR 特征跟踪分析。通过结合 RV GLS 和 RV 后负荷的三个拟议替代指标（肺动脉收缩压 (PASP)、肺血管阻力 (PVR) 和肺动脉顺应性 (PAC)）来评估 RV-动脉耦合。 18-FDG 正电子发射断层扫描 (PET) 分析用于评估 RV 葡萄糖摄取，以 SUVRV/LV 表示。本研究的随访时间为25个月，临床终点定义为死亡或临床恶化。耦合参数（RV GLS/PASP、RV GLS/PVR 和 RV GLS*PAC）与 RV 功能和标准化摄取值 (SUVRV/LV) 显着相关。经历临床终点的患者 (n = 18) 在基线访视时耦合参数明显较差。 RV GLS/PASP 在预测临床终点方面具有最高的曲线下面积，且值高于 (−)0.29%/mmHg 的患者预后明显较差。它也是多变量分析中临床终点的具有统计学意义的预测因子（调整后的 R2 = 0.68；p < 0.001）。耦合参数与 PAH 中的 RV 血流动力学和葡萄糖代谢相关。 结合 CMR 和血流动力学测量可以更全面地评估 PAH 患者预后所需的 RV 功能。试用注册：NCT03688698，09/26/2018，追溯注册；协议编号：2017/25/N/NZ5/02689