Ventricular mass as a prognostic imaging biomarker in incident pulmonary arterial hypertension

Simpson, Carol; Damico, Rachel; Kolb, Todd M.; Mathai, Stephen C.; Khair, Rubina; Sato, Takahiro; Bourji, Khalil I.; Tedford, Ryan J.; Zimmerman, Stefan L.; Hassoun, Paul M.

doi:10.1183/13993003.02067-2018

Cited by 22 publications

(25 citation statements)

References 14 publications

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“…Our comprehensive search identified a total of 22 studies that were included in the meta-analysis ( 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ). The details of the literature search are presented in the supplemental materials, including a Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow diagram ( Supplemental Appendix 3 ).…”

Section: Resultsmentioning

confidence: 99%

“…( 24 ), 2015 Japan PCS 2009–2013 68 76 55 ± 22 37 ± 11 10 17 4 37 24 (9-34) 10 (15) 6 (9) Simpson et al. ( 25 ), 2019 U.S. PCS 2007–2014 64 91 57 ± 11 NR 22 42 50 (29–66) 30 (46) Swift et al. ( 26 ), 2017 U.K. RCS 2008–2015 576 54 57 ± 16 48 ± 13 260 195 63 58 42 (17–142) 221 (38) van de Veerdonk et al.…”

Section: Resultsmentioning

confidence: 99%

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Cardiac-MRI Predicts Clinical Worsening and Mortality in Pulmonary Arterial Hypertension

Alabed¹,

Shahin²,

Garg

et al. 2021

JACC: Cardiovascular Imaging

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Objectives This meta-analysis evaluates assessment of pulmonary arterial hypertension (PAH), with a focus on clinical worsening and mortality. Background Cardiac magnetic resonance (CMR) has prognostic value in the assessment of patients with PAH. However, there are limited data on the prediction of clinical worsening, an important composite endpoint used in PAH therapy trials. Methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Web of Science databases were searched in May 2020. All CMR studies assessing clinical worsening and the prognosis of patients with PAH were included. Pooled hazard ratios of univariate regression analyses for CMR measurements, for prediction of clinical worsening and mortality, were calculated. Results Twenty-two studies with 1,938 participants were included in the meta-analysis. There were 18 clinical worsening events and 8 deaths per 100 patient-years. The pooled hazard ratios show that every 1% decrease in right ventricular (RV) ejection fraction is associated with a 4.9% increase in the risk of clinical worsening over 22 months of follow-up and a 2.2% increase in the risk of death over 54 months. For every 1 ml/m 2 increase in RV end-systolic volume index or RV end-diastolic volume index, the risk of clinical worsening increases by 1.3% and 0.7%, respectively, and the risk of mortality increases by 0.9% and 1%. Every 1 ml/m 2 decrease in left ventricular end-systolic volume index or left ventricular end-diastolic volume index increased the risk of death by 2.1% and 2.3%. Left ventricular parameters were not associated with clinical worsening. Conclusions This review confirms CMR as a powerful prognostic marker in PAH in a large cohort of patients. In addition to confirming previous observations that RV function and RV and left ventricular volumes predict mortality, RV function and volumes also predict clinical worsening. This study provides a strong rationale for considering CMR as a clinically relevant endpoint for trials of PAH therapies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Cardiac-MRI Predicts Clinical Worsening and Mortality in Pulmonary Arterial Hypertension

Alabed¹,

Shahin²,

Garg

et al. 2021

JACC: Cardiovascular Imaging

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“…In the current issue of the European Respiratory Journal, SIMPSON et al [6] have performed a thorough analysis to investigate the relationship between ventricular mass and survival in 64 incident PAH patients (42 connective tissue disease-associated PAH, 22 idiopathic PAH). During a median follow-up of 4.2 years, 30 deaths occurred (46% mortality), which demonstrates once again the devastating nature of this disease.…”

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confidence: 99%

“…There is clearly an unmet need for new studies in which the role of RV hypertrophy is further elucidated by either stimulating RV hypertrophy and enhancing angiogenesis or directly inhibiting RV hypertrophy at different stages of the disease. The study SIMPSON et al [6] clearly demonstrates that RV hypertrophy is a prognostic marker of PAH, triggering our minds to rethink the concept of RV hypertrophy. The results of this study urges us to explore the role of RV hypertrophy in PAH in more detail in the future.…”

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confidence: 99%

The unknown pathophysiological relevance of right ventricular hypertrophy in pulmonary arterial hypertension

2019

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“…However, there was evidence of pulmonary hypertension on CMRI as demonstrated by a higher ventricular mass index (VMI) in our population compared to similar population of COPD and no PH studied by Johns et al 29 VMI correlates with invasive measurement of pulmonary artery pressure and has been shown to be a prognostic marker in pulmonary hypertension. 30,31 Another possible explanation for the negative result for the primary outcome is that the study population consisted mostly of patients with COPD (93%) and a few patients suffering from ILD (7%). It was agreed at the time when the study was designed to include patients suffering from group 3 pulmonary hypertension.…”

Section: Figurementioning

confidence: 99%

<p>Allopurinol in Patients with Pulmonary Hypertension Associated with Chronic Lung Disease</p>

Lipworth¹,

Weir‐McCall²,

Houston³

et al. 2020

COPD

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Background: Oxidative stress (OS) has been implicated in the development of pulmonary hypertension (PH) and ventricular hypertrophy. Xanthine oxidase is a well-recognised source of reactive oxygen species, which lead to OS. The aim of this proof of concept study was to assess whether allopurinol (xanthine oxidase inhibitor) would reduce right ventricular mass (RVM) in patients with PH-associated chronic lung disease (PH-CLD). Methods: We conducted a randomised, double-blind, parallel-group, placebo-controlled trial in patients with PH-CLD (93% COPD, 7% IPF) who were randomly assigned to receive allopurinol or placebo for 12 months. The primary outcome was the mean change in RVM, as assessed by cardiac magnetic resonance imaging (CMRI). Secondary outcomes included quality of life (QOL), spirometry and six-minute walk test (6MWT). Results: Seventy-one patients were recruited: mean age 71 years, mean pulmonary arterial pressure 30 mm Hg, FEV 1 60% and resting SpO 2 96%. After 12 months, there was no significant difference in the change in RVM from baseline (allopurinol 1.85g vs placebo 0.97g with mean difference 0.88g, CI −4.77 to 3.01, p =0.7). There were also no significant changes in other cardiac parameters measured on MRI, in QOL, spirometry and 6MWT. Subgroup analysis showed that allopurinol significantly reduced RVM compared to placebo with-6.16g vs 0.75g and mean difference 6.92g (CI 1.14 to 12.69, p = 0.02) in COPD patients with more severe airflow limitation. Conclusion: Allopurinol had no overall impact on patients with PH-CLD but had potential benefit in COPD patients with more severe airflow limitation.

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Ventricular mass as a prognostic imaging biomarker in incident pulmonary arterial hypertension

Cited by 22 publications

References 14 publications

Cardiac-MRI Predicts Clinical Worsening and Mortality in Pulmonary Arterial Hypertension

Cardiac-MRI Predicts Clinical Worsening and Mortality in Pulmonary Arterial Hypertension

The unknown pathophysiological relevance of right ventricular hypertrophy in pulmonary arterial hypertension

<p>Allopurinol in Patients with Pulmonary Hypertension Associated with Chronic Lung Disease</p>

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