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INDIVIDUAL SHORT TERM VARIABILITY OF CARDIAC INDEX ASSESSED BY CARDIAC MAGNETIC RESONANCE IN PULMONARY ARTERIAL HYPERTENSION
2070 JACC April 5, 2016 Volume 67, Issue 13
Pulmonary Hypertension and Venous Thrombo-embolic Disease INDIVIDUAL SHORT TERM VARIABILITY OF CARDIAC INDEX ASSESSED BY CARDIAC MAGNETIC RESONANCE IN PULMONARY ARTERIAL HYPERTENSION Poster Contributions Poster Area, South Hall A1 Monday, April 04, 2016, 9:45 a.m.-10:30 a.m. Session Title: Novel Prognostic Markers in Pulmonary Vascular Disease Abstract Category: 36. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease Presentation Number: 1265-305 Authors: Christoffer Goransson, Niels Vejlstrup, Jorn Carlsen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Background: Cardiac magnetic resonance imaging (CMR) has emerged as a new standard in assessing combined cardiovascular right ventricular anatomy and function. We have studied the individual variability in cardiac index (CI) by CMR in patients with pulmonary arterial hypertension (PAH) and matched controls. Methods: Patients with PAH and healthy age- and gender-matched controls underwent three CMRs with one-week intervals. The studies were performed at the same time of the day and on the same MRI-scanner. Cardiac output was calculated using aortic flow by velocityencoded CMR and indexed to body surface area, CI. Mixed effects model statistics was applied, and a significance level of α = 0.05 used.
Results: The study population included 10 PAH patients, six females, age 43 ± 8 years and 10 healthy controls with six females, age 43 ± 10 years. The patients all had idiopathic PAH, including one of vasoreactive phenotype. Patients were on PAH specific medication (intravenous treprostinil in combination therapy (n=8), sildenafil monotherapy (n=1) and calcium antagonist (n=1)). Patients had improved from NYHA functional class II-IV at baseline to NYHA FC I-II at inclusion in the study. One patient was excluded due to frequent extrasystoles, making CI calculated by velocity-encoded flow unreliable. CI in patients with PAH was 2.7 l/min/m² compared to 3.1 l/min/m² in healthy controls (p = 0,07). Patients with PAH had a lower individual variability on three repetitive measurements than healthy controls (SD= 0.17 vs 0.31 l/min/m²) (p = 0.02). Two standard deviations of CI represent 13% individual weekly variation in CI in patients with PAH compared to 20% variation in healthy controls. Conclusions: This is the first demonstration that week-to week variation in cardiac index in PAH is less pronounced than in matched controls, and a negative deviation of CI greater than 13% implies a decline in cardiac function. Repetitive CMR offers a noninvasive option for risk assessment and cardiovascular deterioration in patients treated with specific therapy for pulmonary arterial hypertension.
Pulmonary Hypertension and Venous Thrombo-embolic Disease INDIVIDUAL SHORT TERM VARIABILITY OF CARDIAC INDEX ASSESSED BY CARDIAC MAGNETIC RESONANCE IN PULMONARY ARTERIAL HYPERTENSION Poster Contributions Poster Area, South Hall A1 Monday, April 04, 2016, 9:45 a.m.-10:30 a.m. Session Title: Novel Prognostic Markers in Pulmonary Vascular Disease Abstract Category: 36. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease Presentation Number: 1265-305 Authors: Christoffer Goransson, Niels Vejlstrup, Jorn Carlsen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Background: Cardiac magnetic resonance imaging (CMR) has emerged as a new standard in assessing combined cardiovascular right ventricular anatomy and function. We have studied the individual variability in cardiac index (CI) by CMR in patients with pulmonary arterial hypertension (PAH) and matched controls. Methods: Patients with PAH and healthy age- and gender-matched controls underwent three CMRs with one-week intervals. The studies were performed at the same time of the day and on the same MRI-scanner. Cardiac output was calculated using aortic flow by velocityencoded CMR and indexed to body surface area, CI. Mixed effects model statistics was applied, and a significance level of α = 0.05 used.
Results: The study population included 10 PAH patients, six females, age 43 ± 8 years and 10 healthy controls with six females, age 43 ± 10 years. The patients all had idiopathic PAH, including one of vasoreactive phenotype. Patients were on PAH specific medication (intravenous treprostinil in combination therapy (n=8), sildenafil monotherapy (n=1) and calcium antagonist (n=1)). Patients had improved from NYHA functional class II-IV at baseline to NYHA FC I-II at inclusion in the study. One patient was excluded due to frequent extrasystoles, making CI calculated by velocity-encoded flow unreliable. CI in patients with PAH was 2.7 l/min/m² compared to 3.1 l/min/m² in healthy controls (p = 0,07). Patients with PAH had a lower individual variability on three repetitive measurements than healthy controls (SD= 0.17 vs 0.31 l/min/m²) (p = 0.02). Two standard deviations of CI represent 13% individual weekly variation in CI in patients with PAH compared to 20% variation in healthy controls. Conclusions: This is the first demonstration that week-to week variation in cardiac index in PAH is less pronounced than in matched controls, and a negative deviation of CI greater than 13% implies a decline in cardiac function. Repetitive CMR offers a noninvasive option for risk assessment and cardiovascular deterioration in patients treated with specific therapy for pulmonary arterial hypertension.