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Journal of Cardiovascular Magnetic Resonance

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Open Access 01-12-2015 | Research

Pulmonary artery to aorta ratio for the detection of pulmonary hypertension: cardiovascular magnetic resonance and invasive hemodynamics in heart failure with preserved ejection fraction

Authors: Gültekin Karakus, Andreas A. Kammerlander, Stefan Aschauer, Beatrice A. Marzluf, Caroline Zotter-Tufaro, Alina Bachmann, Aleks Degirmencioglu, Franz Duca, Jamil Babayev, Stefan Pfaffenberger, Diana Bonderman, Julia Mascherbauer

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2015

Abstract

Background

Previous work indicates that dilatation of the pulmonary artery (PA) itself or in relation to the ascending aorta (PA:Ao ratio) predicts pulmonary hypertension (PH). Whether these results also apply for heart failure with preserved ejection fraction (HFpEF) is unknown.

In the present study we evaluated the diagnostic and prognostic power of PA diameter and PA:Ao ratio on top of right ventricular (RV) size, function, and septomarginal trabeculation (SMT) thickness by cardiovascular magnetic resonance (CMR) in HFpEF.

Methods and Results

159 consecutive HFpEF patients were prospectively enrolled. Of these, 111 underwent CMR and invasive hemodynamic evaluation.

By invasive assessment 64 % of patients suffered from moderate/severe PH (mean pulmonary artery pressure (mPAP) ≥30 mmHg). Significant differences between groups with and without moderate/severe PH were observed with respect to PA diameter (30.9 ± 5.1 mm versus 26 ± 5.1 mm, p < 0.001), PA:Ao ratio (0.93 ± 0.16 versus 0.78 ± 0.14, p < 0.001), and SMT diameter (4.6 ± 1.5 mm versus 3.8 ± 1.2 mm; p = 0.008). The strongest correlation with mPAP was found for PA:Ao ratio (r = 0.421, p < 0.001). By ROC analysis the best cut-off for the detection of moderate/severe PH was found for a PA:Ao ratio of 0.83.

Patients were followed for 22.0 ± 14.9 months. By Kaplan Meier analysis event-free survival was significantly worse in patients with a PA:Ao ratio ≥0.83 (log rank, p = 0.004). By multivariable Cox-regression analysis PA:Ao ratio was independently associated with event-free survival (p = 0.003).

Conclusion

PA:Ao ratio is an easily measureable noninvasive indicator for the presence and severity of PH in HFpEF, and it is related with outcome.

Guazzi M. Pulmonary hypertension in heart failure preserved ejection fraction: Prevalence, pathophysiology, and clinical perspectives. Circ Heart Fail. 2014;7:367–77.CrossRefPubMed

Lee DS, Gona P, Vasan RS, Larson MG, Benjamin EJ, Wang TJ, et al. Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: Insights from the framingham heart study of the national heart, lung, and blood institute. Circulation. 2009;119:3070–7.PubMedCentralCrossRefPubMed

Vachiery JL, Adir Y, Barbera JA, Champion H, Coghlan JG, Cottin V, et al. Pulmonary hypertension due to left heart diseases. J Am Coll Cardiol. 2013;62:D100–8.CrossRefPubMed

Lam CS, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM. Pulmonary hypertension in heart failure with preserved ejection fraction: A community-based study. J Am Coll Cardiol. 2009;53:1119–26.PubMedCentralCrossRefPubMed

Zotter-Tufaro C, Mascherbauer J, Duca F, Koell B, Aschauer S, Kammerlander AA, et al. Prognostic significance and determinants of the six-minute walk test in patients with heart failure and preserved ejection fraction. JACC Heart Fail. 2014;[accepted for publication, #JHF082514-0348-TR]

Mascherbauer J, Marzluf BA, Tufaro C, Pfaffenberger S, Graf A, Wexberg P, et al. Cardiac magnetic resonance postcontrast t1 time is associated with outcome in patients with heart failure and preserved ejection fraction. Circ Cardiovasc Imaging. 2013;6:1056–65.CrossRefPubMed

Perez VA, Haddad F, Zamanian RT. Diagnosis and management of pulmonary hypertension associated with left ventricular diastolic dysfunction. Pulm Circ. 2012;2:163–9.PubMedCentralCrossRefPubMed

Fisher MR, Forfia PR, Chamera E, Housten-Harris T, Champion HC, Girgis RE, et al. Accuracy of doppler echocardiography in the hemodynamic assessment of pulmonary hypertension. Am J Respir Crit Care Med. 2009;179:615–21.PubMedCentralCrossRefPubMed

Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the american society of echocardiography endorsed by the european association of echocardiography, a registered branch of the european society of cardiology, and the canadian society of echocardiography. J Am Soc Echocardiogr. 2010;23:685–713. quiz 786–688.CrossRefPubMed

10.

McLure LE, Peacock AJ. Cardiac magnetic resonance imaging for the assessment of the heart and pulmonary circulation in pulmonary hypertension. Eur Respir J. 2009;33:1454–66.CrossRefPubMed

11.

Chan AL, Juarez MM, Shelton DK, MacDonald T, Li CS, Lin TC, et al. Novel computed tomographic chest metrics to detect pulmonary hypertension. BMC Med Imaging. 2011;11:7.PubMedCentralCrossRefPubMed

12.

Corson N, Armato 3rd SG, Labby ZE, Straus C, Starkey A, Gomberg-Maitland M. Ct-based pulmonary artery measurements for the assessment of pulmonary hypertension. Acad Radiol. 2014;21:523–30.PubMedCentralCrossRefPubMed

13.

Iyer AS, Wells JM, Vishin S, Bhatt SP, Wille KM, Dransfield MT. Ct scan-measured pulmonary artery to aorta ratio and echocardiography for detecting pulmonary hypertension in severe copd. Chest. 2014;145:824–32.PubMedCentralCrossRefPubMed

14.

Ng CS, Wells AU, Padley SP. A ct sign of chronic pulmonary arterial hypertension: The ratio of main pulmonary artery to aortic diameter. J Thorac Imaging. 1999;14:270–8.CrossRefPubMed

15.

Rajaram S, Swift AJ, Capener D, Elliot CA, Condliffe R, Davies C, et al. Comparison of the diagnostic utility of cardiac magnetic resonance imaging, computed tomography, and echocardiography in assessment of suspected pulmonary arterial hypertension in patients with connective tissue disease. J Rheumatol. 2012;39:1265–74.CrossRefPubMed

16.

Vogel-Claussen J, Shehata ML, Lossnitzer D, Skrok J, Singh S, Boyce D, et al. Increased right ventricular septomarginal trabeculation mass is a novel marker for pulmonary hypertension: Comparison with ventricular mass index and right ventricular mass. Invest Radiol. 2011;46:567–75.PubMedCentralCrossRefPubMed

17.

Paulus WJ, Tschope C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE, et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the heart failure and echocardiography associations of the european society of cardiology. Eur Heart J. 2007;28:2539–50.CrossRefPubMed

18.

Baim D. Grossman´s cardiac catheterization, angiography, and intervention. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.

19.

Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the task force for the diagnosis and treatment of pulmonary hypertension of the european society of cardiology (esc) and the european respiratory society (ers), endorsed by the international society of heart and lung transplantation (ishlt). Eur Heart J. 2009;30:2493–537.CrossRefPubMed

20.

Kramer CM, Barkhausen J, Flamm SD, Kim RJ, Nagel E. Standardized cardiovascular magnetic resonance (cmr) protocols 2013 update. J Cardiovasc Magn Reson. 2013;15:91.PubMedCentralCrossRefPubMed

21.

Zotter-Tufaro C, Duca F, Kammerlander A, Koell B, Aschauer S, Dalos D, et al. Diastolic pressure gradient predicts outcome in patients with heart failure and preserved ejection fraction. J Am Coll Cardiol. 2015;[accepted for publication. JACC030215-0720RR]

22.

Morris DA, Gailani M, Vaz Perez A, Blaschke F, Dietz R, Haverkamp W, et al. Right ventricular myocardial systolic and diastolic dysfunction in heart failure with normal left ventricular ejection fraction. J Am Soc Echocardiogr. 2011;24:886–97.CrossRefPubMed

23.

Mohammed SF, Hussain I, Abou Ezzeddine OF, Takahama H, Kwon SH, Forfia P, et al. Right ventricular function in heart failure with preserved ejection fraction: A community based study. Circulation. 2014;130:2310.CrossRefPubMed

24.

Burke MA, Katz DH, Beussink L, Selvaraj S, Gupta DK, Fox J, et al. Prognostic importance of pathophysiologic markers in patients with heart failure and preserved ejection fraction. Circ Heart Fail. 2014;7:288–99.CrossRefPubMed

25.

Melenovsky V, Hwang SJ, Lin G, Redfield MM, Borlaug BA. Right heart dysfunction in heart failure with preserved ejection fraction. Eur Heart J. 2014;35:3452–62.CrossRefPubMed

26.

Aschauer S, Zotter-Tufaro C, Kammerlander AA, Pfaffenberger S, Marzluf BA, Bonderman D, et al. The right heart in hfpef, insights from a cardiac magnetic resonance study. Eur Heart J. 2014;35(Abstract Supplement):532.

27.

Goliasch G, Tufaro C, Aschauer S, Kammerlander A, Pfaffenberger S, Mascherbauer J, et al. Outcome in heart failure with preserved ejection fraction strongly depends on right ventricular performance. Eur Heart J. 2014;35(Abstract Supplement):1036.

28.

Hoeper MM, Lee SH, Voswinckel R, Palazzini M, Jais X, Marinelli A, et al. Complications of right heart catheterization procedures in patients with pulmonary hypertension in experienced centers. J Am Coll Cardiol. 2006;48:2546–52.CrossRefPubMed

29.

Linguraru MG, Pura JA, Gladwin MT, Koroulakis AI, Minniti C, Machado RF, et al. Computed tomography correlates with cardiopulmonary hemodynamics in pulmonary hypertension in adults with sickle cell disease. Pulm Circ. 2014;4:319–29.PubMedCentralCrossRefPubMed

30.

Bouchard A, Higgins CB, Byrd 3rd BF, Amparo EG, Osaki L, Axelrod R. Magnetic resonance imaging in pulmonary arterial hypertension. Am J Cardiol. 1985;56:938–42.CrossRefPubMed

31.

Ghio S, Pazzano AS, Klersy C, Scelsi L, Raineri C, Camporotondo R, et al. Clinical and prognostic relevance of echocardiographic evaluation of right ventricular geometry in patients with idiopathic pulmonary arterial hypertension. Am J Cardiol. 2011;107:628–32.CrossRefPubMed

32.

Pattynama PM, Lamb HJ, Van der Velde EA, Van der Geest RJ, Van der Wall EE, De Roos A. Reproducibility of mri-derived measurements of right ventricular volumes and myocardial mass. Magn Reson Imaging. 1995;13:53–63.CrossRefPubMed

33.

Roeleveld RJ, Marcus JT, Boonstra A, Postmus PE, Marques KM, Bronzwaer JG, et al. A comparison of noninvasive mri-based methods of estimating pulmonary artery pressure in pulmonary hypertension. J Magn Reson Imaging. 2005;22:67–72.CrossRefPubMed

34.

Saba TS, Foster J, Cockburn M, Cowan M, Peacock AJ. Ventricular mass index using magnetic resonance imaging accurately estimates pulmonary artery pressure. Eur Respir J. 2002;20:1519–24.CrossRefPubMed

35.

Swift AJ, Rajaram S, Hurdman J, Hill C, Davies C, Sproson TW, et al. Noninvasive estimation of pa pressure, flow, and resistance with cmr imaging: Derivation and prospective validation study from the aspire registry. JACC Cardiovasc Imaging. 2013;6:1036–47.CrossRefPubMed

36.

Grapsa J, O'Regan DP, Pavlopoulos H, Durighel G, Dawson D, Nihoyannopoulos P. Right ventricular remodelling in pulmonary arterial hypertension with three-dimensional echocardiography: Comparison with cardiac magnetic resonance imaging. Eur J Echocardiogr. 2010;11:64–73.CrossRefPubMed

37.

Kosinski A, Kozlowski D, Nowinski J, Lewicka E, Dabrowska-Kugacka A, Raczak G, et al. Morphogenetic aspects of the septomarginal trabecula in the human heart. Arch Med Sci. 2010;6:733–43.PubMedCentralCrossRefPubMed

Title: Pulmonary artery to aorta ratio for the detection of pulmonary hypertension: cardiovascular magnetic resonance and invasive hemodynamics in heart failure with preserved ejection fraction
Authors: Gültekin Karakus
Andreas A. Kammerlander
Stefan Aschauer
Beatrice A. Marzluf
Caroline Zotter-Tufaro
Alina Bachmann
Aleks Degirmencioglu
Franz Duca
Jamil Babayev
Stefan Pfaffenberger
Diana Bonderman
Julia Mascherbauer
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2015
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/s12968-015-0184-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pulmonary artery to aorta ratio for the detection of pulmonary hypertension: cardiovascular magnetic resonance and invasive hemodynamics in heart failure with preserved ejection fraction

Abstract

Background

Methods and Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods and Results

Conclusion

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