Utility of cardiac magnetic resonance feature tracking strain assessment in chronic thromboembolic pulmonary hypertension for prediction of REVEAL 2.0 high risk status
Abstract Chronic thromboembolic pulmonary hypertension may be cured by pulmonary endarterectomy (PEA). Thromboembolic disease distribution/PEA success primarily determines prognosis but risk scoring criteria may be adjunctive. Right ventriculoarterial (RV‐PA) and ventriculoatrial (RV‐right atrium [R...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-01-01
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| Series: | Pulmonary Circulation |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/pul2.12116 |
| _version_ | 1827944806058295296 |
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| author | Kai'En Leong Luke Howard Francesco Lo Giudice Rachel Davies Gulammehdi Haji Simon Gibbs Deepa Gopalan |
| author_facet | Kai'En Leong Luke Howard Francesco Lo Giudice Rachel Davies Gulammehdi Haji Simon Gibbs Deepa Gopalan |
| author_sort | Kai'En Leong |
| collection | DOAJ |
| description | Abstract Chronic thromboembolic pulmonary hypertension may be cured by pulmonary endarterectomy (PEA). Thromboembolic disease distribution/PEA success primarily determines prognosis but risk scoring criteria may be adjunctive. Right ventriculoarterial (RV‐PA) and ventriculoatrial (RV‐right atrium [RA]) coupling may be evaluated by cardiac MRI (CMR) feature tracking deformation/strain assessment. We characterized biatrial and biventricular CMR feature tracking (FT) strain parameters following PEA and tested the ability of CMR FT to identify REVEAL 2.0 high‐risk status. We undertook a retrospective single‐center cross‐sectional study of patients (n = 57) who underwent PEA (2015–2020). All underwent pre and postoperative catheterization and CMR. Pulmonary arterial hypertension validated risk scores were calculated. Significant postoperative improvements were observed in mean pulmonary artery pressure (mPAP) (pre‐op 45 ± 11 mmHg vs. post‐op 26 ± 11 mmHg; p < 0.001) and PVR however a large proportion had residual pulmonary hypertension (45%; mPAP ≥25 mmHg). PEA augmented left heart filling with left ventricular end diastolic volume index and left atrial volume index increment. Left ventricular ejection fraction was unchanged postoperatively but LV global longitudinal strain improved (pre‐op median −14.2% vs. post‐op −16.0%; p < 0.001). Right ventricular (RV) geometry and function also improved with reduction in RV mass. Most had uncoupled RV‐PA relationships which recovered (pre‐op right ventricular free wall longitudinal strain −13.2 ± 4.8%, RV stroke volume/right ventricular end systolic volume ratio 0.78 ± 0.53 vs. post‐op −16.8 ± 4.2%, 1.32 ± 0.55; both p < 0.001). Postoperatively, there were six REVEAL 2.0 high‐risk patients, best predicted by impaired RA strain which was superior to traditional volumetric parameters (area under the curve [AUC] 0.99 vs. RVEF AUC 0.88). CMR deformation/strain evaluation can offer insights into coupling recovery; RA strain may be an expeditious surrogate for the more laborious REVEAL 2.0 score. |
| first_indexed | 2024-03-13T10:35:28Z |
| format | Article |
| id | doaj.art-d51a2bb4acab434a80e691e5bbaa437d |
| institution | Directory Open Access Journal |
| issn | 2045-8940 |
| language | English |
| last_indexed | 2024-03-13T10:35:28Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Pulmonary Circulation |
| spelling | doaj.art-d51a2bb4acab434a80e691e5bbaa437d2023-05-18T06:26:29ZengWileyPulmonary Circulation2045-89402023-01-01131n/an/a10.1002/pul2.12116Utility of cardiac magnetic resonance feature tracking strain assessment in chronic thromboembolic pulmonary hypertension for prediction of REVEAL 2.0 high risk statusKai'En Leong0Luke Howard1Francesco Lo Giudice2Rachel Davies3Gulammehdi Haji4Simon Gibbs5Deepa Gopalan6Department of Radiology Imperial College Healthcare NHS Trust/Hammersmith Hospital London UKNational Pulmonary Hypertension Service Imperial College Healthcare NHS Trust London UKNational Pulmonary Hypertension Service Imperial College Healthcare NHS Trust London UKNational Pulmonary Hypertension Service Imperial College Healthcare NHS Trust London UKNational Pulmonary Hypertension Service Imperial College Healthcare NHS Trust London UKNational Heart & Lung Institute Imperial College London London UKDepartment of Radiology Imperial College Healthcare NHS Trust/Hammersmith Hospital London UKAbstract Chronic thromboembolic pulmonary hypertension may be cured by pulmonary endarterectomy (PEA). Thromboembolic disease distribution/PEA success primarily determines prognosis but risk scoring criteria may be adjunctive. Right ventriculoarterial (RV‐PA) and ventriculoatrial (RV‐right atrium [RA]) coupling may be evaluated by cardiac MRI (CMR) feature tracking deformation/strain assessment. We characterized biatrial and biventricular CMR feature tracking (FT) strain parameters following PEA and tested the ability of CMR FT to identify REVEAL 2.0 high‐risk status. We undertook a retrospective single‐center cross‐sectional study of patients (n = 57) who underwent PEA (2015–2020). All underwent pre and postoperative catheterization and CMR. Pulmonary arterial hypertension validated risk scores were calculated. Significant postoperative improvements were observed in mean pulmonary artery pressure (mPAP) (pre‐op 45 ± 11 mmHg vs. post‐op 26 ± 11 mmHg; p < 0.001) and PVR however a large proportion had residual pulmonary hypertension (45%; mPAP ≥25 mmHg). PEA augmented left heart filling with left ventricular end diastolic volume index and left atrial volume index increment. Left ventricular ejection fraction was unchanged postoperatively but LV global longitudinal strain improved (pre‐op median −14.2% vs. post‐op −16.0%; p < 0.001). Right ventricular (RV) geometry and function also improved with reduction in RV mass. Most had uncoupled RV‐PA relationships which recovered (pre‐op right ventricular free wall longitudinal strain −13.2 ± 4.8%, RV stroke volume/right ventricular end systolic volume ratio 0.78 ± 0.53 vs. post‐op −16.8 ± 4.2%, 1.32 ± 0.55; both p < 0.001). Postoperatively, there were six REVEAL 2.0 high‐risk patients, best predicted by impaired RA strain which was superior to traditional volumetric parameters (area under the curve [AUC] 0.99 vs. RVEF AUC 0.88). CMR deformation/strain evaluation can offer insights into coupling recovery; RA strain may be an expeditious surrogate for the more laborious REVEAL 2.0 score.https://doi.org/10.1002/pul2.12116feature tracking (CMR‐FT)pulmonary endarterectomystrainventriculoarterial couplingventriculoatrial coupling |
| spellingShingle | Kai'En Leong Luke Howard Francesco Lo Giudice Rachel Davies Gulammehdi Haji Simon Gibbs Deepa Gopalan Utility of cardiac magnetic resonance feature tracking strain assessment in chronic thromboembolic pulmonary hypertension for prediction of REVEAL 2.0 high risk status Pulmonary Circulation feature tracking (CMR‐FT) pulmonary endarterectomy strain ventriculoarterial coupling ventriculoatrial coupling |
| title | Utility of cardiac magnetic resonance feature tracking strain assessment in chronic thromboembolic pulmonary hypertension for prediction of REVEAL 2.0 high risk status |
| title_full | Utility of cardiac magnetic resonance feature tracking strain assessment in chronic thromboembolic pulmonary hypertension for prediction of REVEAL 2.0 high risk status |
| title_fullStr | Utility of cardiac magnetic resonance feature tracking strain assessment in chronic thromboembolic pulmonary hypertension for prediction of REVEAL 2.0 high risk status |
| title_full_unstemmed | Utility of cardiac magnetic resonance feature tracking strain assessment in chronic thromboembolic pulmonary hypertension for prediction of REVEAL 2.0 high risk status |
| title_short | Utility of cardiac magnetic resonance feature tracking strain assessment in chronic thromboembolic pulmonary hypertension for prediction of REVEAL 2.0 high risk status |
| title_sort | utility of cardiac magnetic resonance feature tracking strain assessment in chronic thromboembolic pulmonary hypertension for prediction of reveal 2 0 high risk status |
| topic | feature tracking (CMR‐FT) pulmonary endarterectomy strain ventriculoarterial coupling ventriculoatrial coupling |
| url | https://doi.org/10.1002/pul2.12116 |
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