TY - JOUR
T1 - Toward the Implementation of Optimal Cardiac Magnetic Resonance Risk Stratification in Pulmonary Arterial Hypertension
AU - Celant, Lucas R.
AU - Wessels, Jeroen N.
AU - Marcus, J. Tim
AU - Meijboom, Lilian J.
AU - Bogaard, Harm Jan
AU - de Man, Frances S.
AU - Vonk Noordegraaf, Anton
N1 - Funding Information: H. J. B., A. V. N., and F. S. d. M. were supported by The Netherlands CardioVascular Research Initiative : The Dutch Heart Foundation, the Dutch Federation of University Medical Centres , The Netherlands Organisation for Health Research and Development , and the Royal Netherlands Academy of Sciences [Grants CVON-2012-08 PHAEDRA, CVON-2018-29 PHAEDRA-IMPACT, CVON-2017-10 Dolphin-Genesis]. A. V. N. and F. S. d. M. were further supported by The Netherlands Organization for Scientific Research [Grants now-VICI: 918.16.610, NWO-VIDI: 917.18.338]. F. S. d, M. was supported by the Dutch Heart Foundation Dekker senior post-doc grant [Grant 2018T059] and received research grant support from Janssen and BIAL. Publisher Copyright: © 2023 The Author(s)
PY - 2024/1
Y1 - 2024/1
N2 - Background: The 2022 European Society of Cardiology/European Respiratory Society pulmonary hypertension (PH) guidelines incorporate cardiac magnetic resonance (CMR) imaging metrics in the risk stratification of patients with pulmonary arterial hypertension (PAH). Thresholds to identify patients at estimated 1-year mortality risks of < 5%, 5% to 20%, and > 20% are introduced. However, these cutoff values are mostly single center-based and require external validation. Research Question: What are the discriminative prognostic properties of the current CMR risk thresholds stratifying patients with PAH? Study Design and Methods: We analyzed data from incident, treatment-naïve patients with PAH from the Amsterdam University Medical Centres, Vrije Universiteit, The Netherlands. The discriminative properties of the proposed CMR three risk strata were tested at baseline and first reassessment, using the following PH guideline variables: right ventricular ejection fraction, indexed right ventricular end-systolic volume, and indexed left ventricular stroke volume. Results: A total of 258 patients with PAH diagnosed between 2001 and 2022 fulfilled the study criteria and were included in this study. Of these, 172 had follow-up CMR imaging after 3 months to 1.5 years. According to the CMR three risk strata, most patients were classified at intermediate risk (n = 115 [45%]) upon diagnosis. Only 29 (11%) of patients with PAH were classified at low risk, and 114 (44%) were classified at high risk. Poor survival discrimination was seen between risk groups. Appropriate survival discrimination was seen at first reassessment. Interpretation: Risk stratifying patients with PAH with the recent proposed CMR cutoffs from the European Society of Cardiology/European Respiratory Society 2022 PH guidelines requires adjustment because post-processing consensus is lacking and general applicability is limited. Risk assessment at follow-up yielded better survival discrimination, emphasizing the importance of the individual treatment response.
AB - Background: The 2022 European Society of Cardiology/European Respiratory Society pulmonary hypertension (PH) guidelines incorporate cardiac magnetic resonance (CMR) imaging metrics in the risk stratification of patients with pulmonary arterial hypertension (PAH). Thresholds to identify patients at estimated 1-year mortality risks of < 5%, 5% to 20%, and > 20% are introduced. However, these cutoff values are mostly single center-based and require external validation. Research Question: What are the discriminative prognostic properties of the current CMR risk thresholds stratifying patients with PAH? Study Design and Methods: We analyzed data from incident, treatment-naïve patients with PAH from the Amsterdam University Medical Centres, Vrije Universiteit, The Netherlands. The discriminative properties of the proposed CMR three risk strata were tested at baseline and first reassessment, using the following PH guideline variables: right ventricular ejection fraction, indexed right ventricular end-systolic volume, and indexed left ventricular stroke volume. Results: A total of 258 patients with PAH diagnosed between 2001 and 2022 fulfilled the study criteria and were included in this study. Of these, 172 had follow-up CMR imaging after 3 months to 1.5 years. According to the CMR three risk strata, most patients were classified at intermediate risk (n = 115 [45%]) upon diagnosis. Only 29 (11%) of patients with PAH were classified at low risk, and 114 (44%) were classified at high risk. Poor survival discrimination was seen between risk groups. Appropriate survival discrimination was seen at first reassessment. Interpretation: Risk stratifying patients with PAH with the recent proposed CMR cutoffs from the European Society of Cardiology/European Respiratory Society 2022 PH guidelines requires adjustment because post-processing consensus is lacking and general applicability is limited. Risk assessment at follow-up yielded better survival discrimination, emphasizing the importance of the individual treatment response.
KW - cardiac magnetic resonance
KW - pulmonary arterial hypertension
KW - right ventricle
KW - risk stratification
UR - http://www.scopus.com/inward/record.url?scp=85175246061&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.chest.2023.07.028
DO - https://doi.org/10.1016/j.chest.2023.07.028
M3 - Article
C2 - 37527773
SN - 0012-3692
VL - 165
SP - 181
EP - 191
JO - Chest
JF - Chest
IS - 1
ER -