Abstract
Background: In pulmonary arterial hypertension (PAH), chronic pressure overload leads to right ventricular (RV) dilatation, hypertrophy and ultimately RV failure and death. Yet, the relevance of changes in RV mass and the interaction with changes in pulmonary pressure have never been investigated.
Objectives: To assess the relationship between changes in pulmonary pressure, changes in RV mass and survival in PAH patients under PAH targeted therapies.
Methods: 45 patients underwent right heart catheterization to measure mean pulmonary artery pressure (mPAP) and cardiac magnetic resonance to assess RV mass before and after 12 months of therapy. RV mass was indexed for body surface area. During long-term follow-up of 59±27 months, 11 patients died.
Results: At baseline, survivors and non-survivors showed a similar mPAP (p=0.43) and RV mass index (p=0.06). RV mass index correlated to mPAP (R=0.51, p<0.01). During 1-year follow-up, changes in mPAP did not differ between survivors (-8±28%) and non-survivors (3±30%) (p=0.86). Overall, RV mass increased by 11±26% (p=0.03). Survivors showed an increased RV mass (17±25%; p<0.01), non-survivors showed an unchanged RV mass (-7±11%; p=0.16). Changes in RV mass were unrelated to age (p=0.50) or gender (p=0.44). Changes in RV mass were unrelated to changes in mPAP (R=0.14; p=0.37).
A decreased RV mass was associated with mortality (HR: 0.95; 95%-CI 0.91-0.99; p=0.02) whereas changes in mPAP did not relate to mortality (HR: 1.01; 95%-CI 0.98–1.02; p=0.25).
Conclusions: In PAH, changes in mPAP were not followed by changes in RV mass. An increased RV mass during follow-up was associated with a favorable prognosis.
- © 2011 ERS