Identification of Cardiac MRI and Bio-Marker Thresholds for One-Year Survival in Pre-Capillary Pulmonary Hypertension: Prospective Study
Identification of Cardiac MRI and Bio-Marker Thresholds for One-Year Survival in Pre-Capillary Pulmonary Hypertension: Prospective Study
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DOI：
10.3390/medicina56040167
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发表时间：
2020-04-01
影响因子：
2.6
通讯作者：
Ereminiene, Egle
中科院分区：
文献类型：
--
作者：
Padervinskiene, Lina;Hoppenot, Deimante;Ereminiene, Egle
背景和目标：心脏的非侵入性成像在肺动脉高压（PAH）的诊断和管理中具有重要地位。本研究的目的是建立心脏磁共振成像（CMRI）衍生的双心室变形阈值、功能参数和N末端脑钠肽前体（NT-proBNP）水平，以预测毛细血管前肺动脉高压（PHprecap）患者的生存率。材料和方法：总共有64例接受CMRI的PHprecap病例连续入选前瞻性队列研究。患者接受了系统评价，包括NT-proBNP测量、二维（2D）超声心动图、6分钟步行试验（6 MWT）、CMRI特征跟踪（FT）和右心导管插入术（RHC）。根据一年生存率将患者分为两组（生存组和非生存组）。进行生存分析。结果：1年生存率为79.6%。年龄、性别、平均肺动脉压（mPAP）、纽约心脏协会（NYHA）心功能分级和6 MWT之间的分布在两组之间没有差异。与结缔组织病（CTD-PAH）相关的PAH组的生存率显著较低，其中44%（n = 4）的患者在第一年内死亡。单因素分析显示，右心室（RV）射血分数（EF）-14.18%和右肺动脉（RPA）相对面积变化（RAC）1738（ng/L）严重降低表明PHprecap患者的死亡风险增加。结论：RV收缩功能受损和LV整体纵向应变、肺动脉扩张性降低和CTD-PAH病因以及高NT-proBNP水平损害了毛细血管前PH患者的预后。这些发现对毛细血管前肺动脉高压患者的危险分层和管理具有重要意义。
Background and objectives: Non-invasive imaging of the heart has an important place in the diagnosis and management of pulmonary arterial hypertension (PAH). The aim of this study was to establish the thresholds of cardiac magnetic resonance imaging (CMRI)-derived biventricular deformation, function parameters, and levels of N-terminal pro brain natriuretic peptide (NT-proBNP) for the prediction of survival of pre-capillary pulmonary hypertension (PHprecap) patients. Materials and Methods: In total, 64 incident PHprecap cases, who underwent CMRI, were consecutively enrolled in a prospective cohort study. Patients underwent a systemic evaluation, including measurement of NT-proBNP, two-dimensional (2D) echocardiography, six-minute walk test (6MWT), CMRI with feature tracking (FT), and right-heart catheterization (RHC). Patients were divided into two groups according to one-year survival (survival and non-survival groups). Survival analysis was performed. Results: One-year survival was 79.6%. The distribution between age, sex, mean pulmonary artery pressure (mPAP), New York Heart Association (NYHA) functional class, and 6MWT did not differ between the groups. Survival was significantly lower in the PAH group associated with connective tissue disease (CTD-PAH), where 44% (n = 4) of patients died during the first year. Univariate analysis revealed that severely reduced right-ventricle (RV) ejection fraction (EF) -14.18%, and right pulmonary artery (RPA) relative area change (RAC) 1738 (ng/L) indicate an increased risk of death in PHprecap patients. Conclusions: Impaired RV systolic function and LV global longitudinal strain, decrease of pulmonary artery distensibility, and CTD-PAH etiology, together with high NT-proBNP level, impair prognosis in pre-capillary PH patients. These findings are important for the risk stratification and management of pre-capillary pulmonary hypertension patients.