Identification of Cardiac Magnetic Resonance Imaging Thresholds for Risk Stratification in Pulmonary Arterial Hypertension
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...
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| Veröffentlicht in: | American journal of respiratory and critical care medicine 2020-02, Vol.201 (4), p.458-468 |
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| creator | Lewis, Robert A Johns, Christopher S Cogliano, Marcella Capener, David Tubman, Euan Elliot, Charlie A Charalampopoulos, Athanasios Sabroe, Ian Thompson, A A Roger Billings, Catherine G Hamilton, Neil Baster, Kathleen Laud, Peter J Hickey, Peter M Middleton, Jennifer Armstrong, Iain J Hurdman, Judith A Lawrie, Allan Rothman, Alexander M K Wild, Jim M Condliffe, Robin Swift, Andrew J Kiely, David G |
| description | 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.
This study evaluates whether cardiac magnetic resonance imaging (MRI) thresholds can be identified and used to aid risk stratification and facilitate decision-making.
Consecutive patients with PAH (
= 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.
A percentage-predicted right ventricular end-systolic volume index threshold of 227% or a left ventricular end-diastolic volume index of 58 ml/m
identified patients at low (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 |
| doi_str_mv | 10.1164/rccm.201909-1771OC |
| format | Article |
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This study evaluates whether cardiac magnetic resonance imaging (MRI) thresholds can be identified and used to aid risk stratification and facilitate decision-making.
Consecutive patients with PAH (
= 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.
A percentage-predicted right ventricular end-systolic volume index threshold of 227% or a left ventricular end-diastolic volume index of 58 ml/m
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.
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.</description><identifier>ISSN: 1073-449X</identifier><identifier>EISSN: 1535-4970</identifier><identifier>DOI: 10.1164/rccm.201909-1771OC</identifier><identifier>PMID: 31647310</identifier><language>eng</language><publisher>United States: American Thoracic Society</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Clinical decision making ; Decision making ; Female ; Health risk assessment ; Humans ; Magnetic Resonance Imaging - methods ; Male ; Middle Aged ; NMR ; Nuclear magnetic resonance ; Original ; Predictive Value of Tests ; Pulmonary Arterial Hypertension - diagnosis ; Pulmonary Arterial Hypertension - physiopathology ; Pulmonary Artery - diagnostic imaging ; Pulmonary hypertension ; Risk Assessment - methods</subject><ispartof>American journal of respiratory and critical care medicine, 2020-02, Vol.201 (4), p.458-468</ispartof><rights>Copyright American Thoracic Society Feb 15, 2020</rights><rights>Copyright © 2020 by the American Thoracic Society 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c430t-f79b42d07751733e8c89c089f1f6dc6813cc3bc08f164c44da53e82286a142a13</citedby><cites>FETCH-LOGICAL-c430t-f79b42d07751733e8c89c089f1f6dc6813cc3bc08f164c44da53e82286a142a13</cites><orcidid>0000-0003-0184-6502</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,4011,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31647310$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lewis, Robert A</creatorcontrib><creatorcontrib>Johns, Christopher S</creatorcontrib><creatorcontrib>Cogliano, Marcella</creatorcontrib><creatorcontrib>Capener, David</creatorcontrib><creatorcontrib>Tubman, Euan</creatorcontrib><creatorcontrib>Elliot, Charlie A</creatorcontrib><creatorcontrib>Charalampopoulos, Athanasios</creatorcontrib><creatorcontrib>Sabroe, Ian</creatorcontrib><creatorcontrib>Thompson, A A Roger</creatorcontrib><creatorcontrib>Billings, Catherine G</creatorcontrib><creatorcontrib>Hamilton, Neil</creatorcontrib><creatorcontrib>Baster, Kathleen</creatorcontrib><creatorcontrib>Laud, Peter J</creatorcontrib><creatorcontrib>Hickey, Peter M</creatorcontrib><creatorcontrib>Middleton, Jennifer</creatorcontrib><creatorcontrib>Armstrong, Iain J</creatorcontrib><creatorcontrib>Hurdman, Judith A</creatorcontrib><creatorcontrib>Lawrie, Allan</creatorcontrib><creatorcontrib>Rothman, Alexander M K</creatorcontrib><creatorcontrib>Wild, Jim M</creatorcontrib><creatorcontrib>Condliffe, Robin</creatorcontrib><creatorcontrib>Swift, Andrew J</creatorcontrib><creatorcontrib>Kiely, David G</creatorcontrib><title>Identification of Cardiac Magnetic Resonance Imaging Thresholds for Risk Stratification in Pulmonary Arterial Hypertension</title><title>American journal of respiratory and critical care medicine</title><addtitle>Am J Respir Crit Care Med</addtitle><description>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.
This study evaluates whether cardiac magnetic resonance imaging (MRI) thresholds can be identified and used to aid risk stratification and facilitate decision-making.
Consecutive patients with PAH (
= 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.
A percentage-predicted right ventricular end-systolic volume index threshold of 227% or a left ventricular end-diastolic volume index of 58 ml/m
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.
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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Clinical decision making</subject><subject>Decision making</subject><subject>Female</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>NMR</subject><subject>Nuclear magnetic resonance</subject><subject>Original</subject><subject>Predictive Value of Tests</subject><subject>Pulmonary Arterial Hypertension - diagnosis</subject><subject>Pulmonary Arterial Hypertension - physiopathology</subject><subject>Pulmonary Artery - diagnostic imaging</subject><subject>Pulmonary hypertension</subject><subject>Risk Assessment - methods</subject><issn>1073-449X</issn><issn>1535-4970</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkVFLHDEUhYO0VGv7B3wogb74MjY3yWySl4IsVhcUi7XQt5DNJLuxM8mazBT01zfLqtg-5ZL7ncM9HISOgJwAzPiXbO1wQgkoohoQAq7ne-gAWtY2XAnyps5EsIZz9WsfvS_ljhCgEsg7tM-qXDAgB-hx0bk4Bh-sGUOKOHk8N7kLxuIrs4puDBbfuJKiidbhxWBWIa7w7Tq7sk59V7BPGd-E8hv_GLN5ZRQi_j71QxXmB3yaR5eD6fHFw8bVOZaKfEBvvemL-_j0HqKf385u5xfN5fX5Yn562VjOyNh4oZacdkSIFgRjTlqpLJHKg591diaBWcuW9cfXUJbzzrQVolTODHBqgB2irzvfzbQcXGdr3mx6vclhqLfpZIL-dxPDWq_SHy0IV4q11eD4ySCn-8mVUQ-hWNf3Jro0FU0ZkS1IRWVFP_-H3qUpxxqvUq3kUtJ2exHdUTanUrLzL8cA0dtq9bZavatW76qtok-vY7xInrtkfwHdeqKw</recordid><startdate>20200215</startdate><enddate>20200215</enddate><creator>Lewis, Robert A</creator><creator>Johns, Christopher S</creator><creator>Cogliano, Marcella</creator><creator>Capener, David</creator><creator>Tubman, Euan</creator><creator>Elliot, Charlie A</creator><creator>Charalampopoulos, Athanasios</creator><creator>Sabroe, Ian</creator><creator>Thompson, A A Roger</creator><creator>Billings, Catherine G</creator><creator>Hamilton, Neil</creator><creator>Baster, Kathleen</creator><creator>Laud, Peter J</creator><creator>Hickey, Peter M</creator><creator>Middleton, Jennifer</creator><creator>Armstrong, Iain J</creator><creator>Hurdman, Judith A</creator><creator>Lawrie, Allan</creator><creator>Rothman, Alexander M K</creator><creator>Wild, Jim M</creator><creator>Condliffe, Robin</creator><creator>Swift, Andrew J</creator><creator>Kiely, David G</creator><general>American Thoracic Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-0184-6502</orcidid></search><sort><creationdate>20200215</creationdate><title>Identification of Cardiac Magnetic Resonance Imaging Thresholds for Risk Stratification in Pulmonary Arterial Hypertension</title><author>Lewis, Robert A ; Johns, Christopher S ; Cogliano, Marcella ; Capener, David ; Tubman, Euan ; Elliot, Charlie A ; Charalampopoulos, Athanasios ; Sabroe, Ian ; Thompson, A A Roger ; Billings, Catherine G ; Hamilton, Neil ; Baster, Kathleen ; Laud, Peter J ; Hickey, Peter M ; Middleton, Jennifer ; Armstrong, Iain J ; Hurdman, Judith A ; Lawrie, Allan ; Rothman, Alexander M K ; Wild, Jim M ; Condliffe, Robin ; Swift, Andrew J ; Kiely, David G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c430t-f79b42d07751733e8c89c089f1f6dc6813cc3bc08f164c44da53e82286a142a13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Clinical decision making</topic><topic>Decision making</topic><topic>Female</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>NMR</topic><topic>Nuclear magnetic resonance</topic><topic>Original</topic><topic>Predictive Value of Tests</topic><topic>Pulmonary Arterial Hypertension - diagnosis</topic><topic>Pulmonary Arterial Hypertension - physiopathology</topic><topic>Pulmonary Artery - diagnostic imaging</topic><topic>Pulmonary hypertension</topic><topic>Risk Assessment - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lewis, Robert A</creatorcontrib><creatorcontrib>Johns, Christopher S</creatorcontrib><creatorcontrib>Cogliano, Marcella</creatorcontrib><creatorcontrib>Capener, David</creatorcontrib><creatorcontrib>Tubman, Euan</creatorcontrib><creatorcontrib>Elliot, Charlie A</creatorcontrib><creatorcontrib>Charalampopoulos, Athanasios</creatorcontrib><creatorcontrib>Sabroe, Ian</creatorcontrib><creatorcontrib>Thompson, A A Roger</creatorcontrib><creatorcontrib>Billings, Catherine G</creatorcontrib><creatorcontrib>Hamilton, Neil</creatorcontrib><creatorcontrib>Baster, Kathleen</creatorcontrib><creatorcontrib>Laud, Peter J</creatorcontrib><creatorcontrib>Hickey, Peter M</creatorcontrib><creatorcontrib>Middleton, Jennifer</creatorcontrib><creatorcontrib>Armstrong, Iain J</creatorcontrib><creatorcontrib>Hurdman, Judith A</creatorcontrib><creatorcontrib>Lawrie, Allan</creatorcontrib><creatorcontrib>Rothman, Alexander M K</creatorcontrib><creatorcontrib>Wild, Jim M</creatorcontrib><creatorcontrib>Condliffe, Robin</creatorcontrib><creatorcontrib>Swift, Andrew J</creatorcontrib><creatorcontrib>Kiely, David G</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of respiratory and critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lewis, Robert A</au><au>Johns, Christopher S</au><au>Cogliano, Marcella</au><au>Capener, David</au><au>Tubman, Euan</au><au>Elliot, Charlie A</au><au>Charalampopoulos, Athanasios</au><au>Sabroe, Ian</au><au>Thompson, A A Roger</au><au>Billings, Catherine G</au><au>Hamilton, Neil</au><au>Baster, Kathleen</au><au>Laud, Peter J</au><au>Hickey, Peter M</au><au>Middleton, Jennifer</au><au>Armstrong, Iain J</au><au>Hurdman, Judith A</au><au>Lawrie, Allan</au><au>Rothman, Alexander M K</au><au>Wild, Jim M</au><au>Condliffe, Robin</au><au>Swift, Andrew J</au><au>Kiely, David G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Identification of Cardiac Magnetic Resonance Imaging Thresholds for Risk Stratification in Pulmonary Arterial Hypertension</atitle><jtitle>American journal of respiratory and critical care medicine</jtitle><addtitle>Am J Respir Crit Care Med</addtitle><date>2020-02-15</date><risdate>2020</risdate><volume>201</volume><issue>4</issue><spage>458</spage><epage>468</epage><pages>458-468</pages><issn>1073-449X</issn><eissn>1535-4970</eissn><abstract>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.
This study evaluates whether cardiac magnetic resonance imaging (MRI) thresholds can be identified and used to aid risk stratification and facilitate decision-making.
Consecutive patients with PAH (
= 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.
A percentage-predicted right ventricular end-systolic volume index threshold of 227% or a left ventricular end-diastolic volume index of 58 ml/m
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.
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.</abstract><cop>United States</cop><pub>American Thoracic Society</pub><pmid>31647310</pmid><doi>10.1164/rccm.201909-1771OC</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-0184-6502</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1073-449X |
| ispartof | American journal of respiratory and critical care medicine, 2020-02, Vol.201 (4), p.458-468 |
| issn | 1073-449X 1535-4970 |
| language | eng |
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| source | MEDLINE; American Thoracic Society (ATS) Journals Online; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult Aged Aged, 80 and over Clinical decision making Decision making Female Health risk assessment Humans Magnetic Resonance Imaging - methods Male Middle Aged NMR Nuclear magnetic resonance Original Predictive Value of Tests Pulmonary Arterial Hypertension - diagnosis Pulmonary Arterial Hypertension - physiopathology Pulmonary Artery - diagnostic imaging Pulmonary hypertension Risk Assessment - methods |
| title | Identification of Cardiac Magnetic Resonance Imaging Thresholds for Risk Stratification in Pulmonary Arterial Hypertension |
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