Chest
Original ResearchPulmonary Vascular DiseaseProgressive Changes in Right Ventricular Geometric Shortening and Long-term Survival in Pulmonary Arterial Hypertension
Section snippets
Patient Population
The present study was performed in an observational cohort of patients with PAH and was part of a prospective ongoing research project aimed to evaluate the RV in PAH by means of MRI. Between May 2003 and May 2005, 287 patients were referred to our hospital for the evaluation of pulmonary hypertension. A diagnosis of PAH was established while following a standard protocol that included right-sided heart catheterization (RHC).11 We selected treatment-naive patients with PAH who underwent cardiac
Patient Characteristics
The baseline demographic and hemodynamic data of both the survivors and nonsurvivors are summarized in Table 1. In four survivors and four nonsurvivors, no RHC was performed at 1-year follow-up within 2 weeks of CMR assessment. The nonsurvivors had a mean survival of 2.5 ± 1 years. There was no difference between the survivors and nonsurvivors with respect to age and sex. The nonsurvivor group comprised more patients with connective tissue disease, a greater number of patients in New York Heart
Discussion
We investigated the pathophysiologic changes in RV geometry in patients with PAH in the first year after diagnosis and related the geometric changes occurring during this initial year to subsequent survival. The major finding of this study is the following characterization of RV properties in subsequent nonsurvivors: (1) Longitudinal shortening and transverse shortening are already reduced at baseline; (2) both longitudinal shortening and RV free wall motion stay the same over time in
Conclusions
Progressive RV failure in PAH is associated with a parallel decline in RV longitudinal and transverse free wall displacement until a floor effect is reached for both. A further reduction of RV function is due to progressive leftward septal displacement. Because transverse shortening incorporates both free wall and septum displacement, this parameter can be used to monitor the decline of RV function in end-stage PAH.
Acknowledgments
Author contributions: Mr Mauritz and Dr Kind had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Mr Mauritz: contributed to the study design; data collection, analysis, and interpretation; and manuscript preparation, revision, and final approval.
Dr Kind: contributed to the study design; writing the Matlab software; data collection; and manuscript preparation, revision, and final approval.
Dr Marcus:
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Cited by (0)
Mr Mauritz and Dr Kind contributed equally to this article.
Funding/Support: This studywas financially supported by The Netherlands Organisation for Scientific Research (NWO) Toptalent grant [021.001.120 to Dr Kind] and the NWO Vidi Grant [91.796.306 to Dr Vonk-Noordegraaf].
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).