Right Ventricular Energetic Biomarkers From 4D Flow CMR Are Associated With Exertional Capacity in Pulmonary Arterial Hypertension

Authors

Xiaodan Zhao
Shuang Leng
Ru-San Tan
Ping Chai
Tee Joo Yeo
Jennifer Ann Bryant
Lynette L S Teo
Marielle V Fortier
Wen Ruan
Ting Ting Low
Ching Ching Ong
Shuo Zhang
Rob J van der Geest
John C Allen
Marina Hughes
Pankaj Garg
Teng Hong Tan
James W Yip
Ju Le Tan
Liang Zhong

Publication Date

12-1-2022

Journal

Journal of Cardiovascular Magnetic Resonance

Abstract

BACKGROUND: Cardiovascular magnetic resonance (CMR) offers comprehensive right ventricular (RV) evaluation in pulmonary arterial hypertension (PAH). Emerging four-dimensional (4D) flow CMR allows visualization and quantification of intracardiac flow components and calculation of phasic blood kinetic energy (KE) parameters but it is unknown whether these parameters are associated with cardiopulmonary exercise test (CPET)-assessed exercise capacity, which is a surrogate measure of survival in PAH. We compared 4D flow CMR parameters in PAH with healthy controls, and investigated the association of these parameters with RV remodelling, RV functional and CPET outcomes.

METHODS: PAH patients and healthy controls from two centers were prospectively enrolled to undergo on-site cine and 4D flow CMR, and CPET within one week. RV remodelling index was calculated as the ratio of RV to left ventricular (LV) end-diastolic volumes (EDV). Phasic (peak systolic, average systolic, and peak E-wave) LV and RV blood flow KE indexed to EDV (KEI

RESULTS: 45 PAH patients (46 ± 11 years; 7 M) and 51 healthy subjects (46 ± 14 years; 17 M) with no significant differences in age and gender were analyzed. Compared with healthy controls, PAH had significantly lower median RV direct flow, RV delayed ejection flow, RV peak E-wave KEI

CONCLUSION: In this 4D flow CMR and CPET study, RV direct flow provided incremental value over RVEF for discriminating adverse RV remodelling, impaired exercise capacity, and PAH with intermediate and high risk based on risk score. These data suggest that CMR with 4D flow CMR can provide comprehensive assessment of PAH severity, and may be used to monitor disease progression and therapeutic response.

TRIAL REGISTRATION NUMBER: https://www.

CLINICALTRIALS: gov . Unique identifier: NCT03217240.

Keywords

4D flow CMR, Cardiopulmonary exercise test, Flow components, Kinetic energy, Pulmonary arterial hypertension