Right ventricular energetic biomarkers from 4D Flow CMR are associated with exertional capacity in pulmonary arterial hypertension
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...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-12-01
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| Series: | Journal of Cardiovascular Magnetic Resonance |
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| Online Access: | https://doi.org/10.1186/s12968-022-00896-8 |
| _version_ | 1797204159711150080 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Xiaodan Zhao |
| collection | DOAJ |
| description | 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 (KEIEDV) and ventricular LV and RV flow components (direct flow, retained inflow, delayed ejection flow, and residual volume) were calculated. Oxygen uptake (VO2), carbon dioxide production (VCO2) and minute ventilation (VE) were measured and recorded. 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 KEIEDV, peak VO2, and percentage (%) predicted peak VO2, while significantly higher median RV residual volume and VE/VCO2 slope. RV direct flow and RV residual volume were significantly associated with RV remodelling, function, peak VO2, % predicted peak VO2 and VE/VCO2 slope (all P < 0.01). Multiple linear regression analyses showed RV direct flow to be an independent marker of RV function, remodelling and exercise capacity. 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. |
| first_indexed | 2024-04-11T14:51:16Z |
| format | Article |
| id | doaj.art-fa23b2292ffe44c4b74aa728b197fb70 |
| institution | Directory Open Access Journal |
| issn | 1532-429X |
| language | English |
| last_indexed | 2024-04-24T08:30:48Z |
| publishDate | 2022-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Cardiovascular Magnetic Resonance |
| spelling | doaj.art-fa23b2292ffe44c4b74aa728b197fb702024-04-16T20:29:05ZengElsevierJournal of Cardiovascular Magnetic Resonance1532-429X2022-12-0124111810.1186/s12968-022-00896-8Right ventricular energetic biomarkers from 4D Flow CMR are associated with exertional capacity in pulmonary arterial hypertensionXiaodan Zhao0Shuang Leng1Ru-San Tan2Ping Chai3Tee Joo Yeo4Jennifer Ann Bryant5Lynette L. S. Teo6Marielle V. Fortier7Wen Ruan8Ting Ting Low9Ching Ching Ong10Shuo Zhang11Rob J. van der Geest12John C. Allen13Marina Hughes14Pankaj Garg15Teng Hong Tan16James W. Yip17Ju Le Tan18Liang Zhong19National Heart Centre Singapore, National Heart Research Institute SingaporeNational Heart Centre Singapore, National Heart Research Institute SingaporeNational Heart Centre Singapore, National Heart Research Institute SingaporeNational University Hospital SingaporeNational University Hospital SingaporeNational Heart Centre Singapore, National Heart Research Institute SingaporeNational University Hospital SingaporeDuke-NUS Medical SchoolNational Heart Centre Singapore, National Heart Research Institute SingaporeNational University Hospital SingaporeNational University Hospital SingaporePhilips Healthcare GermanyDepartment of Radiology, Leiden University Medical CenterDuke-NUS Medical SchoolDepartment of Cardiovascular Medicine, University of East AngliaDepartment of Cardiovascular Medicine, University of East AngliaDuke-NUS Medical SchoolNational University Hospital SingaporeNational Heart Centre Singapore, National Heart Research Institute SingaporeNational Heart Centre Singapore, National Heart Research Institute SingaporeAbstract 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 (KEIEDV) and ventricular LV and RV flow components (direct flow, retained inflow, delayed ejection flow, and residual volume) were calculated. Oxygen uptake (VO2), carbon dioxide production (VCO2) and minute ventilation (VE) were measured and recorded. 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 KEIEDV, peak VO2, and percentage (%) predicted peak VO2, while significantly higher median RV residual volume and VE/VCO2 slope. RV direct flow and RV residual volume were significantly associated with RV remodelling, function, peak VO2, % predicted peak VO2 and VE/VCO2 slope (all P < 0.01). Multiple linear regression analyses showed RV direct flow to be an independent marker of RV function, remodelling and exercise capacity. 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.https://doi.org/10.1186/s12968-022-00896-84D flow CMRFlow componentsKinetic energyCardiopulmonary exercise testPulmonary arterial hypertension |
| spellingShingle | 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 Right ventricular energetic biomarkers from 4D Flow CMR are associated with exertional capacity in pulmonary arterial hypertension Journal of Cardiovascular Magnetic Resonance 4D flow CMR Flow components Kinetic energy Cardiopulmonary exercise test Pulmonary arterial hypertension |
| title | Right ventricular energetic biomarkers from 4D Flow CMR are associated with exertional capacity in pulmonary arterial hypertension |
| title_full | Right ventricular energetic biomarkers from 4D Flow CMR are associated with exertional capacity in pulmonary arterial hypertension |
| title_fullStr | Right ventricular energetic biomarkers from 4D Flow CMR are associated with exertional capacity in pulmonary arterial hypertension |
| title_full_unstemmed | Right ventricular energetic biomarkers from 4D Flow CMR are associated with exertional capacity in pulmonary arterial hypertension |
| title_short | Right ventricular energetic biomarkers from 4D Flow CMR are associated with exertional capacity in pulmonary arterial hypertension |
| title_sort | right ventricular energetic biomarkers from 4d flow cmr are associated with exertional capacity in pulmonary arterial hypertension |
| topic | 4D flow CMR Flow components Kinetic energy Cardiopulmonary exercise test Pulmonary arterial hypertension |
| url | https://doi.org/10.1186/s12968-022-00896-8 |
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