AUTHOR=Alandejani Faisal , Hameed Abdul , Tubman Euan , Alabed Samer , Shahin Yousef , Lewis Robert A. , Dwivedi Krit , Mahmood Aqeeb , Middleton Jennifer , Watson Lisa , Alkhanfar Dheyaa , Johns Christopher S. , Rajaram Smitha , Garg Pankaj , Condliffe Robin , Elliot Charlie A. , Thompson A. A. Roger , Rothman Alexander M. K. , Charalampopoulos Athanasios , Lawrie Allan , Wild Jim M. , Swift Andrew J. , Kiely David G. TITLE=Imaging and Risk Stratification in Pulmonary Arterial Hypertension: Time to Include Right Ventricular Assessment JOURNAL=Frontiers in Cardiovascular Medicine VOLUME=9 YEAR=2022 URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.797561 DOI=10.3389/fcvm.2022.797561 ISSN=2297-055X ABSTRACT=Background

Current European Society of Cardiology and European Respiratory Society guidelines recommend regular risk stratification with an aim of treating patients with pulmonary arterial hypertension (PAH) to improve or maintain low-risk status (<5% 1-year mortality).

Methods

Consecutive patients with PAH who underwent cardiac magnetic resonance imaging (cMRI) were identified from the Assessing the Spectrum of Pulmonary hypertension Identified at a Referral centre (ASPIRE) registry. Kaplan–Meier survival curves, locally weighted scatterplot smoothing regression and multi-variable logistic regression analysis were performed.

Results

In 311 consecutive, treatment-naïve patients with PAH undergoing cMRI including 121 undergoing follow-up cMRI, measures of right ventricular (RV) function including right ventricular ejection fraction (RVEF) and RV end systolic volume and right atrial (RA) area had prognostic value. However, only RV metrics were able to identify a low-risk status. Age (p < 0.01) and RVEF (p < 0.01) but not RA area were independent predictors of 1-year mortality.

Conclusion

This study highlights the need for guidelines to include measures of RV function rather than RA area alone to aid the risk stratification of patients with PAH.