Identification of Cardiac Magnetic Resonance Imaging Thresholds for Risk Stratification in Pulmonary Arterial Hypertension
Identification of Cardiac Magnetic Resonance Imaging Thresholds for Risk Stratification in Pulmonary Arterial Hypertension
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DOI：
10.1164/rccm.201909-1771oc
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发表时间：
2020-02-15
影响因子：
24.7
通讯作者：
Kiely, David G.
中科院分区：
文献类型：
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作者：
Lewis, Robert A.;Johns, Christopher S.;Kiely, David G.
依据：肺动脉高压（PAH）是一种缩短寿命的疾病。欧洲心脏病学会和欧洲呼吸学会以及REVEAL（评估早期和长期PAH疾病管理的北美登记研究）风险评分计算器（REVEAL 2.0）确定阈值预测1年死亡率。目的：本研究评估心脏磁共振成像（MRI）阈值是否可以确定并用于辅助风险分层和促进决策。方法：从ASPIRE（评估转诊中心确定的肺动脉高压谱）MRI数据库中确定了接受心脏MRI的PAH患者（n = 438）。测量和主要结果：右心室收缩末期容积指数阈值为227%或左心室舒张末期容积指数为58 ml/m2，可确定患者1年死亡率的低风险（< 5%）和高风险（> 10%）。这些指标分别将63%和34%的患者确定为低风险。右心室射血分数> 54%、37- 54%和< 37%分别确定了21%、43%和36%的患者处于1年死亡率的低、中和高风险。在随访心脏MRI时，改善或维持在低风险组的患者1年死亡率<5%。血管造影预测的右心室收缩末期容积指数可独立预测预后，当与REVEAL 2.0风险评分计算器或改良的法国肺动脉高压登记处方法结合使用时，可改善1年死亡率的风险分层。结论：心脏MRI可用于使用阈值方法对PAH患者进行风险分层。心血管预测的右心室收缩末期容积指数可以识别高比例的1年死亡率低风险患者，当与当前的风险分层方法结合使用时，可以改善风险分层。本研究支持进一步评价心脏MRI在PAH风险分层中的作用。
Rationale: Pulmonary arterial hypertension (PAH) is a life-shortening condition. The European Society of Cardiology and European Respiratory Society and the REVEAL (North American Registry to Evaluate Early and Long-Term PAH Disease Management) risk score calculator (REVEAL 2.0) identify thresholds to predict 1-year mortality.Objectives: This study evaluates whether cardiac magnetic resonance imaging (MRI) thresholds can be identified and used to aid risk stratification and facilitate decision-making.Methods: Consecutive patients with PAH (n = 438) undergoing cardiac MRI were identified from the ASPIRE (Assessing the Spectrum of Pulmonary Hypertension Identified at a Referral Center) MRI database. Thresholds were identified from a discovery cohort and evaluated in a test cohort.Measurements and Main Results: A percentage-predicted right ventricular end-systolic volume index threshold of 227% or a left ventricular end-diastolic volume index of 58 ml/m(2) identified patients at low (< 5%) and high (> 10%) risk of 1-year mortality. These metrics respectively identified 63% and 34% of patients as low risk. Right ventricular ejection fraction > 54%, 37-54%, and < 37% identified 21%, 43%, and 36% of patients at low, intermediate, and high risk, respectively, of 1-year mortality. At follow-up cardiac MRI, patients who improved to or were maintained in a low-risk group had a 1-year mortality < 5%. Percentage-predicted right ventricular end-systolic volume index independently predicted outcome and, when used in conjunction with the REVEAL 2.0 risk score calculator or a modified French Pulmonary Hypertension Registry approach, improved risk stratification for 1-year mortality.Conclusions: Cardiac MRI can be used to risk stratify patients with PAH using a threshold approach. Percentage-predicted right ventricular end-systolic volume index can identify a high percentage of patients at low-risk of 1-year mortality and, when used in conjunction with current risk stratification approaches, can improve risk stratification. This study supports further evaluation of cardiac MRI in risk stratification in PAH.