title: Imaging right ventricular function to predict outcome in pulmonary arterial hypertension.
abstract: BACKGROUND
  Right ventricular (RV) function is a major determinant of outcome in pulmonary arterial hypertension (PAH). However, uncertainty persists about the optimal method of evaluation.
  
  
  METHODS
  We measured RV end-systolic and end-diastolic volumes (ESV and EDV) using cardiac magnetic resonance imaging and RV pressures during right heart catheterization in 140 incident PAH patients and 22 controls. A maximum RV pressure (Pmax) was calculated from the nonlinear extrapolations of early and late systolic portions of the RV pressure curve. The gold standard measure of RV function adaptation to afterload, or RV-arterial coupling (Ees/Ea) was estimated by the stroke volume (SV)/ESV ratio (volume method) or as Pmax/mean pulmonary artery pressure (mPAP) minus 1 (pressure method) (n=84). RV function was also assessed by ejection fraction (EF), right atrial pressure (RAP) and SV.
  
  
  RESULTS
  Higher Ea and RAP, and lower compliance, SV and EF predicted outcome at univariate analysis. Ees/Ea estimated by the pressure method did not predict outcome but Ees/Ea estimated by the volume method (SV/ESV) did. At multivariate analysis, only SV/ESV and EF were independent predictors of outcome. Survival was poorer in patients with a fall in EF or SV/ESV during follow-up (n=44, p=0.008).
  
  
  CONCLUSIONS
  RV function to predict outcome in PAH is best evaluated by imaging derived SV/ESV or EF. In this study, there was no added value of invasive measurements or simplified pressure-derived estimates of RV-arterial coupling.
authors.affiliation: Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK. Electronic address: mbrewis@nhs.net.
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Brewis
authors.affiliation: Department of Biomedical, Chemical and Materials Engineering, San Jose State University, CA, USA.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bellofiore
authors.affiliation: Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Rebecca R
authors.initials: RR
authors.lastname: Vanderpool
authors.affiliation: Department of Biomedical Engineering, University of Wisconsin-Madison, WI, USA.
authors.forename: Naomi C
authors.initials: NC
authors.lastname: Chesler
authors.affiliation: Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK.
authors.forename: Martin K
authors.initials: MK
authors.lastname: Johnson
authors.affiliation: Department of Cardiology, Erasme University Hospital, Brussels, Belgium.
authors.forename: Robert
authors.initials: R
authors.lastname: Naeije
authors.affiliation: Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Peacock
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000503:physiopathology*; D016278:Ventricular Function, Right
keywords: Pressure–volume relationship; Prognosis; Pulmonary hypertension; Right ventricular dysfunction