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CMR assessment of right ventricular-pulmonary arterial coupling and right ventricular trabecular complexity: impact on prognosis in patients undergoing lung transplant assessment.

Session Poster session 1

Speaker Georgia Sarri

Congress : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Imaging - Other
  • Session type : Poster Session
  • FP Number : P190

Authors : G Sarri (Uxbridge,GB), K Halim (Uxbridge,GB), M Mccurry (Uxbridge,GB), I Pierce (Uxbridge,GB), S Rahman-Haley (Uxbridge,GB), A Simon (Uxbridge,GB), M Carby (Uxbridge,GB), A Reed (Uxbridge,GB), J Wong (Uxbridge,GB)

Authors:
G Sarri1 , K Halim1 , M Mccurry1 , I Pierce1 , S Rahman-Haley1 , A Simon1 , M Carby1 , A Reed1 , J Wong1 , 1Harefield Hospital, Royal Brompton and Harefield Foundation Trust - Uxbridge - United Kingdom of Great Britain & Northern Ireland ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii151

Right ventricular (RV) function is prognostic in pulmonary hypertension (PH), but key metrics are unclear. We correlated a CMR index of RV-pulmonary arterial (PA) coupling, as well as RV trabecular complexity by its fractal dimension (FD) to prognosis.

84 patients underwent lung transplant assessment and CMR, with RV FD assessed using freely available code (FracAnalyse); RV-PA coupling was estimated by stroke volume (SV) / RV end systolic volume (ESV) ratio. 

Median follow up was 19.33 ± 17.17 months; 94% of the patients had underlying lung disease. 51 of 66 patients had echo-detected PH. Survival was predicted by SV/ESV, RVEF, indexed RV end-diastolic (EDVi) and ESVi, and mPAP on univariate analysis. Both SV/ESV and RV FD correlated to mPAP, right atrial (RA) area, RVEDVi and RVESVi.  

In patients referred for transplant assessment, RV functional adaptation to afterload on CMR predicted survival on univariate analysis. Fractal analysis of RV trabecular complexity correlated with metrics influencing RV remodelling and contractility.

All patients (n=84), mean/ median SEM/ IQR Alive (n=70), mean/ median SEM/ IQR Dead (n=14), mean/ median SEM/ IQR Alive vs dead p value Hazard Ratio Confidence interval p value
CMR LVEDVi 58 23 59 24 57 19 0.93
CMR LVESVi 22 13 21 13 25 13 0.30
CMR LVEF 62 1.07 63 1.14 58 2.77 0.06
CMR RVEDVi 72 32 70 28 83 62 0.01 1.03 1.01, 1.04 <0.005
CMR RVESVi 41 2.62 37 2.06 64 10.14 0.02 1.03 1.01, 1.04 <0.005
CMR RVEF 51 18 53 15 38 17 .001 0.94 0.90, 0.97 <0.005
LGE 14 9 5 0.04 2.45 0.79, 7.61 0.12
RV-PA coupling SV/ESV 1.03 0.72 1.12 0.67 0.57 0.48 .001 0.12 0.027, 0.52 <0.005
mPAP 27 11 26 10 33 23 0.04 1.05 1.01, 1.09 <0.005
Transplanted 22 15 7 0.03 2.06 0.68, 6.22 0.20
Correlation RV EDVI RV ESVI RV SVI RV EF RA area mPAP
SV/ESV r value -0.407 -0.712 0.250 0.847 -0.231 -0.301
p value <0.001 <0.001 .022 <0.001 .042 .014
Global FD r value .319 .303 .130 -.203 .280 .290
p value <0.005 .005 .238 .064 .013 .018
Maximal Basal FD r value .389 .350 .226 -.196 .296 .267
p value <0.001 <0.005 .039 .073 .008 .030
Mean Basal FD r value .401 .373 .179 -.215 .350 .297
p value <0.001 <0.001 .102 .050 <0.005 .016

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