Ventricular global function index is associated with clinical outcomes in pediatric pulmonary hypertension
Abstract Background Multiple right ventricular (RV) metrics have prognostic value in pulmonary hypertension (PH). A cardiac magnetic resonance imaging (CMR) derived global ventricular function index (GFI) provided improved prediction of composite adverse outcome (CAO) in adults with atherosclerosis....
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-07-01
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| Series: | Journal of Cardiovascular Magnetic Resonance |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12968-023-00947-8 |
| _version_ | 1797784546643542016 |
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| author | Hieu T. Ta Paul J. Critser Michal Schäfer Nicholas J. Ollberding Michael D. Taylor Michael V. Di Maria Russel Hirsch D. Dunbar Ivy Benjamin S. Frank |
| author_facet | Hieu T. Ta Paul J. Critser Michal Schäfer Nicholas J. Ollberding Michael D. Taylor Michael V. Di Maria Russel Hirsch D. Dunbar Ivy Benjamin S. Frank |
| author_sort | Hieu T. Ta |
| collection | DOAJ |
| description | Abstract Background Multiple right ventricular (RV) metrics have prognostic value in pulmonary hypertension (PH). A cardiac magnetic resonance imaging (CMR) derived global ventricular function index (GFI) provided improved prediction of composite adverse outcome (CAO) in adults with atherosclerosis. GFI has not yet been explored in a PH population. We explored the feasibility of GFI as a predictor of CAO in a pediatric PH population. Methods Two center retrospective chart review identified pediatric PH patients undergoing CMR from Jan 2005–June 2021. GFI, defined as the ratio of the stroke volume to the sum of mean ventricular cavity and myocardial volume, was calculated for each patient. CAO was defined as death, lung transplant, Potts shunt, or parenteral prostacyclin initiation after CMR. Cox proportional hazards regression was used to estimate associations and assess model performance between CMR parameters and CAO. Results The cohort comprised 89 patients (54% female, 84% World Health Organization (WHO) Group 1; 70% WHO-FC ≤ 2; and 27% on parenteral prostacyclin). Median age at CMR was 12 years (IQR 8.1–17). Twenty-one (24%) patients experienced CAO during median follow up of 1.5 years. CAO cohort had higher indexed RV volumes (end systolic—145 vs 99 mL/m2, p = 0.003; end diastolic—89 vs 46 mL/m2, p = 0.004) and mass (37 vs 24 gm/m2, p = 0.003), but lower ejection fraction (EF) (42 vs 51%, p < 0.001) and GFI (40 vs 52%, p < 0.001). Higher indexed RV volumes (hazard ratios [HR] 1.01, CI 1.01–1.02), lower RV EF (HR 1.09, CI 1.05–1.12) and lower RV GFI (HR 1.09, CI 1.05–1.11) were associated with increased risk of CAO. In survival analysis, patients with RV GFI < 43% demonstrated decreased event-free survival and increased hazard of CAO compared to those with RV GFI ≥ 43%. In multivariable models, inclusion of GFI provided improved prediction of CAO compared to models incorporating ventricular volumes, mass or EF. Conclusions RV GFI was associated with CAO in this cohort, and inclusion in multivariable models had increased predictive value compared to RVEF. GFI uses readily available CMR data without additional post-processing and may provide additional prognostic value in pediatric PH patients beyond traditional CMR markers. |
| first_indexed | 2024-03-13T00:41:27Z |
| format | Article |
| id | doaj.art-364cb5e4e47344afbca9d27500d21eb7 |
| institution | Directory Open Access Journal |
| issn | 1532-429X |
| language | English |
| last_indexed | 2024-03-13T00:41:27Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiovascular Magnetic Resonance |
| spelling | doaj.art-364cb5e4e47344afbca9d27500d21eb72023-07-09T11:17:20ZengBMCJournal of Cardiovascular Magnetic Resonance1532-429X2023-07-012511910.1186/s12968-023-00947-8Ventricular global function index is associated with clinical outcomes in pediatric pulmonary hypertensionHieu T. Ta0Paul J. Critser1Michal Schäfer2Nicholas J. Ollberding3Michael D. Taylor4Michael V. Di Maria5Russel Hirsch6D. Dunbar Ivy7Benjamin S. Frank8Cincinnati Children’s Hospital Medical CenterCincinnati Children’s Hospital Medical CenterDepartment of Pediatrics Section of Cardiology, University of ColoradoDepartment of Pediatrics, College of Medicine, University of CincinnatiCincinnati Children’s Hospital Medical CenterDepartment of Pediatrics Section of Cardiology, University of ColoradoCincinnati Children’s Hospital Medical CenterDepartment of Pediatrics Section of Cardiology, University of ColoradoDepartment of Pediatrics Section of Cardiology, University of ColoradoAbstract Background Multiple right ventricular (RV) metrics have prognostic value in pulmonary hypertension (PH). A cardiac magnetic resonance imaging (CMR) derived global ventricular function index (GFI) provided improved prediction of composite adverse outcome (CAO) in adults with atherosclerosis. GFI has not yet been explored in a PH population. We explored the feasibility of GFI as a predictor of CAO in a pediatric PH population. Methods Two center retrospective chart review identified pediatric PH patients undergoing CMR from Jan 2005–June 2021. GFI, defined as the ratio of the stroke volume to the sum of mean ventricular cavity and myocardial volume, was calculated for each patient. CAO was defined as death, lung transplant, Potts shunt, or parenteral prostacyclin initiation after CMR. Cox proportional hazards regression was used to estimate associations and assess model performance between CMR parameters and CAO. Results The cohort comprised 89 patients (54% female, 84% World Health Organization (WHO) Group 1; 70% WHO-FC ≤ 2; and 27% on parenteral prostacyclin). Median age at CMR was 12 years (IQR 8.1–17). Twenty-one (24%) patients experienced CAO during median follow up of 1.5 years. CAO cohort had higher indexed RV volumes (end systolic—145 vs 99 mL/m2, p = 0.003; end diastolic—89 vs 46 mL/m2, p = 0.004) and mass (37 vs 24 gm/m2, p = 0.003), but lower ejection fraction (EF) (42 vs 51%, p < 0.001) and GFI (40 vs 52%, p < 0.001). Higher indexed RV volumes (hazard ratios [HR] 1.01, CI 1.01–1.02), lower RV EF (HR 1.09, CI 1.05–1.12) and lower RV GFI (HR 1.09, CI 1.05–1.11) were associated with increased risk of CAO. In survival analysis, patients with RV GFI < 43% demonstrated decreased event-free survival and increased hazard of CAO compared to those with RV GFI ≥ 43%. In multivariable models, inclusion of GFI provided improved prediction of CAO compared to models incorporating ventricular volumes, mass or EF. Conclusions RV GFI was associated with CAO in this cohort, and inclusion in multivariable models had increased predictive value compared to RVEF. GFI uses readily available CMR data without additional post-processing and may provide additional prognostic value in pediatric PH patients beyond traditional CMR markers.https://doi.org/10.1186/s12968-023-00947-8Pediatric pulmonary hypertensionGlobal function indexCardiovascular magnetic resonance |
| spellingShingle | Hieu T. Ta Paul J. Critser Michal Schäfer Nicholas J. Ollberding Michael D. Taylor Michael V. Di Maria Russel Hirsch D. Dunbar Ivy Benjamin S. Frank Ventricular global function index is associated with clinical outcomes in pediatric pulmonary hypertension Journal of Cardiovascular Magnetic Resonance Pediatric pulmonary hypertension Global function index Cardiovascular magnetic resonance |
| title | Ventricular global function index is associated with clinical outcomes in pediatric pulmonary hypertension |
| title_full | Ventricular global function index is associated with clinical outcomes in pediatric pulmonary hypertension |
| title_fullStr | Ventricular global function index is associated with clinical outcomes in pediatric pulmonary hypertension |
| title_full_unstemmed | Ventricular global function index is associated with clinical outcomes in pediatric pulmonary hypertension |
| title_short | Ventricular global function index is associated with clinical outcomes in pediatric pulmonary hypertension |
| title_sort | ventricular global function index is associated with clinical outcomes in pediatric pulmonary hypertension |
| topic | Pediatric pulmonary hypertension Global function index Cardiovascular magnetic resonance |
| url | https://doi.org/10.1186/s12968-023-00947-8 |
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