Tom Alexander Howard Newman, Gareth Matthews, Hosamadin Assadi, Rui Li, Ciaran Grafton-Clarke, Zia Mehmood, Bahman Kasmai, Chris Sawh, Liang Zhong, Samer Alabed, Joao L Cavalcante, Ross J Thomson, Nay Aung, Rob J van der Geest, Andrew J Swift, Pankaj Garg
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引用次数: 0
Abstract
Background: Right atrial pressure (RAP) is a key variable that cardiac MRI (CMR) cannot currently measure. We aimed to develop a model to estimate mean RAP (mRAP) using CMR and assess the prognostic value of CMR-derived mRAP in an independent patient cohort.
Methods: The derivation cohort consisted of patients investigated for heart failure symptoms with right heart catheterisation and CMR. Right atrial and ventricular CMR measurements were correlated with invasive mRAP to inform multivariable linear regression models incorporating patient characteristics. CMR-derived mRAP was tested as a predictor for clinical outcomes (lower-limb oedema, heart failure hospitalisation and all-cause mortality) on an independent cohort of patients receiving CMR. Both cohorts were derived from hospital registries.
Results: In the derivation cohort (n=672), invasive mRAP was >8 mm Hg in 56% of patients. Right atrial end-systolic volume (RAESV) had the strongest correlation with invasive mRAP (Pearson's coefficient 0.58, p<0.01). RAESV was as accurate as more complex models for mRAP prediction (p>0.05). CMR-derived mRAP ≥10 mm Hg was better associated with outcomes than mRAP ≥8 mm Hg in the clinical cohort (n=101) with diagnostic power for peripheral oedema (area under the curve (AUC) 0.75, p=0.02) and heart failure hospitalisation (AUC 0.93, p<0.01). Kaplan-Meier analysis demonstrated elevated CMR-derived mRAP (≥10 mm Hg) was associated with reduced survival compared with mRAP <10 mm Hg (χ2=5, p=0.02) over a mean follow-up of 6.8 years.
Conclusion: mRAP can be estimated by CMR. Raised CMR-derived mRAP is predictive of lower-limb oedema, heart failure hospitalisation and all-cause mortality.
背景:右心房压(RAP)是目前心脏MRI (CMR)无法测量的关键变量。我们的目的是建立一个模型,利用CMR来估计平均RAP (mRAP),并在一个独立的患者队列中评估CMR衍生的mRAP的预后价值。方法:衍生队列包括通过右心导管和CMR检查心衰症状的患者。右心房和心室CMR测量与侵入性mRAP相关,以告知包含患者特征的多变量线性回归模型。在接受CMR的独立队列患者中,CMR衍生的mRAP作为临床结果(下肢水肿、心力衰竭住院和全因死亡率)的预测因子进行了测试。两个队列均来自医院登记。结果:在衍生队列(n=672)中,56%的患者有创mRAP为bb0.8 mm Hg。右心房收缩末期容积(RAESV)与有创mRAP相关性最强(Pearson’s系数0.58,p0.05)。在平均随访6.8年的临床队列(n=101)中,cmr衍生的mRAP≥10 mm Hg比mRAP≥8 mm Hg与外周水肿(曲线下面积(AUC) 0.75, p=0.02)和心力衰竭住院(AUC 0.93, p2=5, p=0.02)的诊断能力更好。结论:CMR可以估计mRAP。cmr衍生的mRAP升高可预测下肢水肿、心力衰竭住院和全因死亡率。
期刊介绍:
Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.