Right ventricular concentric hypertrophy and clinical worsening in idiopathic pulmonary arterial hypertension

Roberto Badagliacca, Roberto Poscia, Beatrice Pezzuto, Silvia Papa, Francesca Pesce, Giovanna Manzi, Elisa Giannetta, Claudia Raineri, Mauro Schina, Susanna Sciomer, Daniela Parola, Marco Francone, Iacopo Carbone, Francesco Fedele, Carmine Dario Vizza

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Because the pathophysiology of idiopathic pulmonary arterial hypertension (IPAH) is an afterload mismatch, wall stress represents the most important feature affecting the overloaded right ventricle (RV). Thus, the RV mass/volume (M/V) ratio may reflect more adequately the suitability of the remodeling pattern in minimizing RV wall stress compared with the lone RV volume. This study investigated the prognostic effect of the RV M/V ratio in IPAH. Methods: Enrolled in our center were 74 therapy-naïve IPAH patients who were prospectively monitored for the presence of clinical worsening (CW). Baseline evaluation included clinical, hemodynamic, and echocardiographic parameters. Cardiac magnetic resonance was used for RV M/V ratio determination. Results: During 541 ± 283 days of follow-up, 31 of 74 patients (42%) presented with CW. Actuarial rates of CW were 14%, 28%, and 46%, at 6, 12, and 24 months, respectively. The RV M/V ratio significantly improved the power of the prognostic model based on traditional clinical, hemodynamic, and imaging parameters (area under the curve: 0.74 vs 0.66, respectively; p = 0.01). When the cutoff values of the RV M/V ratio and cardiac index (CI) derived from receiver operating characteristic curve analysis were combined, patients with a low RV M/V ratio/low CI, low RV M/V ratio/high CI, and high RV M/V ratio/low CI showed a 28.8, 8.8, and 6.1 increase in the hazard ratio, respectively, compared with high RV M/V ratio/high CI patients (p = 0.0001). Conclusions: The RV M/V ratio is an independent predictor of prognosis in IPAH and may allow clinicians to better stratify patients with normal CI, identifying at an early stage those patients at higher risk of right heart failure development before hemodynamic instability appears.

Original languageEnglish
JournalJournal of Heart and Lung Transplantation
DOIs
Publication statusAccepted/In press - 2016

Fingerprint

Right Ventricular Hypertrophy
Heart Ventricles
Hemodynamics
Familial Primary Pulmonary Hypertension
Cardiac Volume
ROC Curve
Area Under Curve

Keywords

  • Cardiac magnetic resonance
  • Echocardiography
  • Pulmonary hypertension
  • Remodeling
  • Right ventricular failure

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Right ventricular concentric hypertrophy and clinical worsening in idiopathic pulmonary arterial hypertension. / Badagliacca, Roberto; Poscia, Roberto; Pezzuto, Beatrice; Papa, Silvia; Pesce, Francesca; Manzi, Giovanna; Giannetta, Elisa; Raineri, Claudia; Schina, Mauro; Sciomer, Susanna; Parola, Daniela; Francone, Marco; Carbone, Iacopo; Fedele, Francesco; Vizza, Carmine Dario.

In: Journal of Heart and Lung Transplantation, 2016.

Research output: Contribution to journalArticle

Badagliacca, R, Poscia, R, Pezzuto, B, Papa, S, Pesce, F, Manzi, G, Giannetta, E, Raineri, C, Schina, M, Sciomer, S, Parola, D, Francone, M, Carbone, I, Fedele, F & Vizza, CD 2016, 'Right ventricular concentric hypertrophy and clinical worsening in idiopathic pulmonary arterial hypertension', Journal of Heart and Lung Transplantation. https://doi.org/10.1016/j.healun.2016.04.006
Badagliacca, Roberto ; Poscia, Roberto ; Pezzuto, Beatrice ; Papa, Silvia ; Pesce, Francesca ; Manzi, Giovanna ; Giannetta, Elisa ; Raineri, Claudia ; Schina, Mauro ; Sciomer, Susanna ; Parola, Daniela ; Francone, Marco ; Carbone, Iacopo ; Fedele, Francesco ; Vizza, Carmine Dario. / Right ventricular concentric hypertrophy and clinical worsening in idiopathic pulmonary arterial hypertension. In: Journal of Heart and Lung Transplantation. 2016.
@article{629d4707854a4e298dfee491ed80ec48,
title = "Right ventricular concentric hypertrophy and clinical worsening in idiopathic pulmonary arterial hypertension",
abstract = "Background: Because the pathophysiology of idiopathic pulmonary arterial hypertension (IPAH) is an afterload mismatch, wall stress represents the most important feature affecting the overloaded right ventricle (RV). Thus, the RV mass/volume (M/V) ratio may reflect more adequately the suitability of the remodeling pattern in minimizing RV wall stress compared with the lone RV volume. This study investigated the prognostic effect of the RV M/V ratio in IPAH. Methods: Enrolled in our center were 74 therapy-na{\"i}ve IPAH patients who were prospectively monitored for the presence of clinical worsening (CW). Baseline evaluation included clinical, hemodynamic, and echocardiographic parameters. Cardiac magnetic resonance was used for RV M/V ratio determination. Results: During 541 ± 283 days of follow-up, 31 of 74 patients (42{\%}) presented with CW. Actuarial rates of CW were 14{\%}, 28{\%}, and 46{\%}, at 6, 12, and 24 months, respectively. The RV M/V ratio significantly improved the power of the prognostic model based on traditional clinical, hemodynamic, and imaging parameters (area under the curve: 0.74 vs 0.66, respectively; p = 0.01). When the cutoff values of the RV M/V ratio and cardiac index (CI) derived from receiver operating characteristic curve analysis were combined, patients with a low RV M/V ratio/low CI, low RV M/V ratio/high CI, and high RV M/V ratio/low CI showed a 28.8, 8.8, and 6.1 increase in the hazard ratio, respectively, compared with high RV M/V ratio/high CI patients (p = 0.0001). Conclusions: The RV M/V ratio is an independent predictor of prognosis in IPAH and may allow clinicians to better stratify patients with normal CI, identifying at an early stage those patients at higher risk of right heart failure development before hemodynamic instability appears.",
keywords = "Cardiac magnetic resonance, Echocardiography, Pulmonary hypertension, Remodeling, Right ventricular failure",
author = "Roberto Badagliacca and Roberto Poscia and Beatrice Pezzuto and Silvia Papa and Francesca Pesce and Giovanna Manzi and Elisa Giannetta and Claudia Raineri and Mauro Schina and Susanna Sciomer and Daniela Parola and Marco Francone and Iacopo Carbone and Francesco Fedele and Vizza, {Carmine Dario}",
year = "2016",
doi = "10.1016/j.healun.2016.04.006",
language = "English",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",

}

TY - JOUR

T1 - Right ventricular concentric hypertrophy and clinical worsening in idiopathic pulmonary arterial hypertension

AU - Badagliacca, Roberto

AU - Poscia, Roberto

AU - Pezzuto, Beatrice

AU - Papa, Silvia

AU - Pesce, Francesca

AU - Manzi, Giovanna

AU - Giannetta, Elisa

AU - Raineri, Claudia

AU - Schina, Mauro

AU - Sciomer, Susanna

AU - Parola, Daniela

AU - Francone, Marco

AU - Carbone, Iacopo

AU - Fedele, Francesco

AU - Vizza, Carmine Dario

PY - 2016

Y1 - 2016

N2 - Background: Because the pathophysiology of idiopathic pulmonary arterial hypertension (IPAH) is an afterload mismatch, wall stress represents the most important feature affecting the overloaded right ventricle (RV). Thus, the RV mass/volume (M/V) ratio may reflect more adequately the suitability of the remodeling pattern in minimizing RV wall stress compared with the lone RV volume. This study investigated the prognostic effect of the RV M/V ratio in IPAH. Methods: Enrolled in our center were 74 therapy-naïve IPAH patients who were prospectively monitored for the presence of clinical worsening (CW). Baseline evaluation included clinical, hemodynamic, and echocardiographic parameters. Cardiac magnetic resonance was used for RV M/V ratio determination. Results: During 541 ± 283 days of follow-up, 31 of 74 patients (42%) presented with CW. Actuarial rates of CW were 14%, 28%, and 46%, at 6, 12, and 24 months, respectively. The RV M/V ratio significantly improved the power of the prognostic model based on traditional clinical, hemodynamic, and imaging parameters (area under the curve: 0.74 vs 0.66, respectively; p = 0.01). When the cutoff values of the RV M/V ratio and cardiac index (CI) derived from receiver operating characteristic curve analysis were combined, patients with a low RV M/V ratio/low CI, low RV M/V ratio/high CI, and high RV M/V ratio/low CI showed a 28.8, 8.8, and 6.1 increase in the hazard ratio, respectively, compared with high RV M/V ratio/high CI patients (p = 0.0001). Conclusions: The RV M/V ratio is an independent predictor of prognosis in IPAH and may allow clinicians to better stratify patients with normal CI, identifying at an early stage those patients at higher risk of right heart failure development before hemodynamic instability appears.

AB - Background: Because the pathophysiology of idiopathic pulmonary arterial hypertension (IPAH) is an afterload mismatch, wall stress represents the most important feature affecting the overloaded right ventricle (RV). Thus, the RV mass/volume (M/V) ratio may reflect more adequately the suitability of the remodeling pattern in minimizing RV wall stress compared with the lone RV volume. This study investigated the prognostic effect of the RV M/V ratio in IPAH. Methods: Enrolled in our center were 74 therapy-naïve IPAH patients who were prospectively monitored for the presence of clinical worsening (CW). Baseline evaluation included clinical, hemodynamic, and echocardiographic parameters. Cardiac magnetic resonance was used for RV M/V ratio determination. Results: During 541 ± 283 days of follow-up, 31 of 74 patients (42%) presented with CW. Actuarial rates of CW were 14%, 28%, and 46%, at 6, 12, and 24 months, respectively. The RV M/V ratio significantly improved the power of the prognostic model based on traditional clinical, hemodynamic, and imaging parameters (area under the curve: 0.74 vs 0.66, respectively; p = 0.01). When the cutoff values of the RV M/V ratio and cardiac index (CI) derived from receiver operating characteristic curve analysis were combined, patients with a low RV M/V ratio/low CI, low RV M/V ratio/high CI, and high RV M/V ratio/low CI showed a 28.8, 8.8, and 6.1 increase in the hazard ratio, respectively, compared with high RV M/V ratio/high CI patients (p = 0.0001). Conclusions: The RV M/V ratio is an independent predictor of prognosis in IPAH and may allow clinicians to better stratify patients with normal CI, identifying at an early stage those patients at higher risk of right heart failure development before hemodynamic instability appears.

KW - Cardiac magnetic resonance

KW - Echocardiography

KW - Pulmonary hypertension

KW - Remodeling

KW - Right ventricular failure

UR - http://www.scopus.com/inward/record.url?scp=84970038930&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84970038930&partnerID=8YFLogxK

U2 - 10.1016/j.healun.2016.04.006

DO - 10.1016/j.healun.2016.04.006

M3 - Article

AN - SCOPUS:84970038930

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

ER -