In:
European Heart Journal, Oxford University Press (OUP), Vol. 40, No. Supplement_1 ( 2019-10-01)
Abstract:
Right ventricular (RV) dysfunction complicating lung disease is prognostic in patients undergoing lung transplantation. However key metrics are not clear. Purpose We assessed RV-pulmonary arterial (PA) coupling and RV trabecular complexity through cardiac magnetic resonance (CMR) imaging in patients undergoing lung transplant assessment. Methods Between 2013 and 2018, 91 consecutive patients underwent lung transplant assessment with echocardiography and CMR (1.5T - Siemens). RV trabecular complexity was assessed by its fractal dimension (FD) on CMR, using freely available code (FracAnalyse). RV functional adaptation to increased afterload was assessed with the RV-PA coupling index (stroke volume (SV)/RV end-systolic volume (ESV) ratio). Results 91 patients (median age 53±15 years, 54% male) were analysed; 97% had underlying lung disease. Median follow up period was 23.8 months. Tricuspid regurgitation was echo-detected in 71 patients; 74% (53 patients) had echo-diagnosed pulmonary hypertension (PH). 85%, 10%, and 4% of PH patients were categorized to WHO PH classification Groups 3, 5 and 1 respectively. Mean LV and RV ejection fraction (EF) were 62±1.01% and 51±15.5%. SV/ESV correlated to CMR indexed RV end-diastolic volume (RVEDVi), indexed RV end-systolic volume (RVESVi), RV EF, right atrial area and echo mean pulmonary artery pressure (mPAP) (r −0.437, r −0.646, r 0.824/all p 〈 0.001; r −0.290/p 0.005; r −0.348/p 0.003 respectively). Global FD also correlated to these parameters (r 0.371, r 0.369/both p 0.001; r −0.245/p 0.021; r 0.352, r 0.403/both p 〈 0.001). RV FD did not differ significantly in patients with PH. Survival was predicted by SV/ESV ratio, RVEF, RVEDVi, RVESVi, and mPAP on univariate analysis (Table). All patients (n=91) Alive (n=77) Dead (n=14) Alive vs dead HR CI p value median/mean/counts (SEM/IQR) median/mean/counts (SEM/IQR) median/mean/counts (SEM/IQR) p value CMR RVESVI (ml/m2) 35 (20) 33 (18) 54 (41) 〈 0.001 1.03 1.02, 1.04 〈 0.001 CMR RVEF (%) 51 (15.5) 53 (13) 38 (15) 0.001 0.93 0.90, 0.93 〈 0.001 RV-PA coupling SV/ESV 1.06 (0.64) 1.13 (0.61) 0.57 (0.38) 〈 0.001 0.10 0.02, 0.46 0.003 6 minute walk test distance (m, n=90) 290 (188) 300 (190) 190 (264) 〈 0.05 0.99 0.99, 1.00 0.13 Transplanted 22 15 7 0.04 2.39 0.80, 7.17 0.12 Echo mPAP (mmHg, n=71) 27 (10.7) 27 (9) 33 (14.8) 〈 0.05 1.05 10.1, 1.05 0.008 Conclusion RV functional adaptation to afterload assessed by CMR may predict survival among patients with underlying lung disease referred for lung transplant assessment. Fractal analysis of RV trabecular complexity correlated with metrics influencing RV remodelling and contractility, although not survival. Assessment in a larger cohort is required to determine utility of these metrics.
Type of Medium:
Online Resource
ISSN:
0195-668X
,
1522-9645
DOI:
10.1093/eurheartj/ehz747.0203
Language:
English
Publisher:
Oxford University Press (OUP)
Publication Date:
2019
detail.hit.zdb_id:
2001908-7
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