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Coronary flow reserve correlates with right ventricular dysfunction and predicts right heart failure in patients with pulmonary arterial hypertension

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The purpose of our study was to investigate myocardial perfusion by comparing coronary sinus flow reserve (CFR) between PAH patients and healthy controls and to correlate CFR with biventricular function and pulmonary hemodynamics using magnetic resonance imaging (MRI)... Thirty-one patients with known or clinically suspected PAH underwent right heart catheterization (RHC) and 3T cardiac MRI on the same day... Twenty patients were found to have PAH, eleven patients did not have PAH... Rest and adenosine-stress coronary sinus flow (CSF) were measured with phase contrast MRI (Figure 1) and adjusted to the biventricular mass... CFR was calculated by dividing stress CSF by resting CSFnorm (CFR = Stress CSF / Rest CSFnorm)... CFR for PAH patients was significantly lower (2.22 [1.40-3.22]) than for controls (3.93 [3.07-5.01], p=0.002) (Table 1, Figure 2) and was inversely correlated with mean pulmonary arterial pressure (r=-0.48, p=0.03), pulmonary vascular resistance index (r=-0.47, p=0.04), RV end-diastolic and end-systolic volume/BSA (r=-0.68, p=0.0009 and r=-0.60, p=0.005), RV mass/BSA (r=-0.79, p<0.0001), biventricular mass/BSA (r=-0.73, p=0.0002), and ventricular mass index (r=-0.66, p=0.001) (Table 2)... On multivariate linear regression analysis, RV mass/BSA was the main predictor of CFR for PAH patients... CFR was able to distinguish between PAH patients with and without right heart failure, defined as RV CI <2.2L/min/m (area under the ROC curve 0.81 (95% CI: 0.55-1.00); sensitivity 83.3%, specificity of 85.7% for a threshold value of 1.67)... PAH patients have a reduced CFR compared to healthy volunteers, which correlates with pulmonary hemodynamics and RV dysfunction... A decreased CFR is predicted by RV mass and may contribute to RV failure... Further studies are warranted to investigate the predictive value of CFR with regards to patient outcome.

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Resting and Stress Coronary Sinus Flow and Coronary Flow Reserve. Bar graphs demonstrate median values and 25th-75th percentiles (error bars) for resting CSF (left), stress CSF (middle) and CFR (right) for each group. Values for PAH patients are shown in blue, those for SSc non-PAH patients in red and those for the control group in green. PAH patients demonstrated a trend toward higher resting and lower stress CSF as well as a significantly lower CFR (*p=0.008) compared to healthy controls. The Non-PAH group demonstrated values in-between those for PAH patients and controls.
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Figure 2: Resting and Stress Coronary Sinus Flow and Coronary Flow Reserve. Bar graphs demonstrate median values and 25th-75th percentiles (error bars) for resting CSF (left), stress CSF (middle) and CFR (right) for each group. Values for PAH patients are shown in blue, those for SSc non-PAH patients in red and those for the control group in green. PAH patients demonstrated a trend toward higher resting and lower stress CSF as well as a significantly lower CFR (*p=0.008) compared to healthy controls. The Non-PAH group demonstrated values in-between those for PAH patients and controls.

Mentions: CFR for PAH patients was significantly lower (2.22 [1.40-3.22]) than for controls (3.93 [3.07-5.01], p=0.002) (Table 1, Figure 2) and was inversely correlated with mean pulmonary arterial pressure (r=-0.48, p=0.03), pulmonary vascular resistance index (r=-0.47, p=0.04), RV end-diastolic and end-systolic volume/BSA (r=-0.68, p=0.0009 and r=-0.60, p=0.005), RV mass/BSA (r=-0.79, p<0.0001), biventricular mass/BSA (r=-0.73, p=0.0002), and ventricular mass index (r=-0.66, p=0.001) (Table 2). On multivariate linear regression analysis, RV mass/BSA was the main predictor of CFR for PAH patients. CFR was able to distinguish between PAH patients with and without right heart failure, defined as RV CI <2.2L/min/m2 (area under the ROC curve 0.81 (95% CI: 0.55-1.00); sensitivity 83.3%, specificity of 85.7% for a threshold value of 1.67).


Coronary flow reserve correlates with right ventricular dysfunction and predicts right heart failure in patients with pulmonary arterial hypertension
Resting and Stress Coronary Sinus Flow and Coronary Flow Reserve. Bar graphs demonstrate median values and 25th-75th percentiles (error bars) for resting CSF (left), stress CSF (middle) and CFR (right) for each group. Values for PAH patients are shown in blue, those for SSc non-PAH patients in red and those for the control group in green. PAH patients demonstrated a trend toward higher resting and lower stress CSF as well as a significantly lower CFR (*p=0.008) compared to healthy controls. The Non-PAH group demonstrated values in-between those for PAH patients and controls.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3106448&req=5

Figure 2: Resting and Stress Coronary Sinus Flow and Coronary Flow Reserve. Bar graphs demonstrate median values and 25th-75th percentiles (error bars) for resting CSF (left), stress CSF (middle) and CFR (right) for each group. Values for PAH patients are shown in blue, those for SSc non-PAH patients in red and those for the control group in green. PAH patients demonstrated a trend toward higher resting and lower stress CSF as well as a significantly lower CFR (*p=0.008) compared to healthy controls. The Non-PAH group demonstrated values in-between those for PAH patients and controls.
Mentions: CFR for PAH patients was significantly lower (2.22 [1.40-3.22]) than for controls (3.93 [3.07-5.01], p=0.002) (Table 1, Figure 2) and was inversely correlated with mean pulmonary arterial pressure (r=-0.48, p=0.03), pulmonary vascular resistance index (r=-0.47, p=0.04), RV end-diastolic and end-systolic volume/BSA (r=-0.68, p=0.0009 and r=-0.60, p=0.005), RV mass/BSA (r=-0.79, p<0.0001), biventricular mass/BSA (r=-0.73, p=0.0002), and ventricular mass index (r=-0.66, p=0.001) (Table 2). On multivariate linear regression analysis, RV mass/BSA was the main predictor of CFR for PAH patients. CFR was able to distinguish between PAH patients with and without right heart failure, defined as RV CI <2.2L/min/m2 (area under the ROC curve 0.81 (95% CI: 0.55-1.00); sensitivity 83.3%, specificity of 85.7% for a threshold value of 1.67).

View Article: PubMed Central - HTML

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

The purpose of our study was to investigate myocardial perfusion by comparing coronary sinus flow reserve (CFR) between PAH patients and healthy controls and to correlate CFR with biventricular function and pulmonary hemodynamics using magnetic resonance imaging (MRI)... Thirty-one patients with known or clinically suspected PAH underwent right heart catheterization (RHC) and 3T cardiac MRI on the same day... Twenty patients were found to have PAH, eleven patients did not have PAH... Rest and adenosine-stress coronary sinus flow (CSF) were measured with phase contrast MRI (Figure 1) and adjusted to the biventricular mass... CFR was calculated by dividing stress CSF by resting CSFnorm (CFR = Stress CSF / Rest CSFnorm)... CFR for PAH patients was significantly lower (2.22 [1.40-3.22]) than for controls (3.93 [3.07-5.01], p=0.002) (Table 1, Figure 2) and was inversely correlated with mean pulmonary arterial pressure (r=-0.48, p=0.03), pulmonary vascular resistance index (r=-0.47, p=0.04), RV end-diastolic and end-systolic volume/BSA (r=-0.68, p=0.0009 and r=-0.60, p=0.005), RV mass/BSA (r=-0.79, p<0.0001), biventricular mass/BSA (r=-0.73, p=0.0002), and ventricular mass index (r=-0.66, p=0.001) (Table 2)... On multivariate linear regression analysis, RV mass/BSA was the main predictor of CFR for PAH patients... CFR was able to distinguish between PAH patients with and without right heart failure, defined as RV CI <2.2L/min/m (area under the ROC curve 0.81 (95% CI: 0.55-1.00); sensitivity 83.3%, specificity of 85.7% for a threshold value of 1.67)... PAH patients have a reduced CFR compared to healthy volunteers, which correlates with pulmonary hemodynamics and RV dysfunction... A decreased CFR is predicted by RV mass and may contribute to RV failure... Further studies are warranted to investigate the predictive value of CFR with regards to patient outcome.

No MeSH data available.