Noninvasively assessed pulmonary artery stiffness predicts mortality in pulmonary arterial hypertension

C Tji-Joong Gan, Jan-Willem Lankhaar, Nico Westerhof, J Tim Marcus, Annemarie Becker, Jos W R Twisk, Anco Boonstra, Pieter E Postmus, Anton Vonk-Noordegraaf

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

AIMS: Decreased total compliance of the pulmonary vascular bed is associated with increased mortality in patients with pulmonary arterial hypertension (PAH). We investigated whether proximal pulmonary artery stiffness, in terms of area distensibility and noninvasively assessed relative area change (RAC), calculated as relative cross-sectional area change, predicts mortality in patients with PAH.

METHODS AND RESULTS: Eighty-six subjects underwent right-heart catheterization and MRI to assess area distensibility and RAC. Patients were followed up to 48 months. Kaplan-Meier plot and Cox proportional hazards regression analyses assessed the predictive value of area distensibility and RAC. In 70 patients, the diagnosis PAH was confirmed, and 16 subjects served as control subjects. In comparison with control subjects, proximal pulmonary arteries of patients were distended (685 +/- 214 mm2 vs 411 +/- 153 mm2, p < 0.001), less distensible (area distensibility = 0.46 +/- 0.38.10(-2) mm Hg(-1) vs 3.69 +/- 1.96.10(-2) mm Hg(-1), p < 0.0001), and RAC was smaller (20 +/- 10% vs 58 +/- 21%, p < 0.0001) [mean +/- SD]. RAC showed an inverse curvilinear relation with mean pulmonary artery pressure (R2 = 0.47). Eighteen patients (26%) died because of cardiopulmonary causes. Patients with a pulmonary artery RAC <or= 16% had a worse prognosis than those with a value > 16% (log-rank p < 0.001). RAC predicted mortality better than area distensibility.

CONCLUSION: Noninvasively measured pulmonary artery RAC predicts mortality in patients with PAH.

Original languageEnglish
Pages (from-to)1906-12
Number of pages7
JournalChest
Volume132
Issue number6
DOIs
Publication statusPublished - Dec 2007

Cite this

@article{59ae9c921d59463683d91e6715dada2c,
title = "Noninvasively assessed pulmonary artery stiffness predicts mortality in pulmonary arterial hypertension",
abstract = "AIMS: Decreased total compliance of the pulmonary vascular bed is associated with increased mortality in patients with pulmonary arterial hypertension (PAH). We investigated whether proximal pulmonary artery stiffness, in terms of area distensibility and noninvasively assessed relative area change (RAC), calculated as relative cross-sectional area change, predicts mortality in patients with PAH.METHODS AND RESULTS: Eighty-six subjects underwent right-heart catheterization and MRI to assess area distensibility and RAC. Patients were followed up to 48 months. Kaplan-Meier plot and Cox proportional hazards regression analyses assessed the predictive value of area distensibility and RAC. In 70 patients, the diagnosis PAH was confirmed, and 16 subjects served as control subjects. In comparison with control subjects, proximal pulmonary arteries of patients were distended (685 +/- 214 mm2 vs 411 +/- 153 mm2, p < 0.001), less distensible (area distensibility = 0.46 +/- 0.38.10(-2) mm Hg(-1) vs 3.69 +/- 1.96.10(-2) mm Hg(-1), p < 0.0001), and RAC was smaller (20 +/- 10{\%} vs 58 +/- 21{\%}, p < 0.0001) [mean +/- SD]. RAC showed an inverse curvilinear relation with mean pulmonary artery pressure (R2 = 0.47). Eighteen patients (26{\%}) died because of cardiopulmonary causes. Patients with a pulmonary artery RAC 16{\%} (log-rank p < 0.001). RAC predicted mortality better than area distensibility.CONCLUSION: Noninvasively measured pulmonary artery RAC predicts mortality in patients with PAH.",
keywords = "Adult, Cardiac Catheterization, Case-Control Studies, Elasticity, Female, Humans, Hypertension, Pulmonary/mortality, Least-Squares Analysis, Magnetic Resonance Imaging, Male, Middle Aged, Predictive Value of Tests, Prognosis, Proportional Hazards Models, Pulmonary Artery/physiopathology",
author = "Gan, {C Tji-Joong} and Jan-Willem Lankhaar and Nico Westerhof and Marcus, {J Tim} and Annemarie Becker and Twisk, {Jos W R} and Anco Boonstra and Postmus, {Pieter E} and Anton Vonk-Noordegraaf",
year = "2007",
month = "12",
doi = "10.1378/chest.07-1246",
language = "English",
volume = "132",
pages = "1906--12",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "6",

}

Noninvasively assessed pulmonary artery stiffness predicts mortality in pulmonary arterial hypertension. / Gan, C Tji-Joong; Lankhaar, Jan-Willem; Westerhof, Nico; Marcus, J Tim; Becker, Annemarie; Twisk, Jos W R; Boonstra, Anco; Postmus, Pieter E; Vonk-Noordegraaf, Anton.

In: Chest, Vol. 132, No. 6, 12.2007, p. 1906-12.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Noninvasively assessed pulmonary artery stiffness predicts mortality in pulmonary arterial hypertension

AU - Gan, C Tji-Joong

AU - Lankhaar, Jan-Willem

AU - Westerhof, Nico

AU - Marcus, J Tim

AU - Becker, Annemarie

AU - Twisk, Jos W R

AU - Boonstra, Anco

AU - Postmus, Pieter E

AU - Vonk-Noordegraaf, Anton

PY - 2007/12

Y1 - 2007/12

N2 - AIMS: Decreased total compliance of the pulmonary vascular bed is associated with increased mortality in patients with pulmonary arterial hypertension (PAH). We investigated whether proximal pulmonary artery stiffness, in terms of area distensibility and noninvasively assessed relative area change (RAC), calculated as relative cross-sectional area change, predicts mortality in patients with PAH.METHODS AND RESULTS: Eighty-six subjects underwent right-heart catheterization and MRI to assess area distensibility and RAC. Patients were followed up to 48 months. Kaplan-Meier plot and Cox proportional hazards regression analyses assessed the predictive value of area distensibility and RAC. In 70 patients, the diagnosis PAH was confirmed, and 16 subjects served as control subjects. In comparison with control subjects, proximal pulmonary arteries of patients were distended (685 +/- 214 mm2 vs 411 +/- 153 mm2, p < 0.001), less distensible (area distensibility = 0.46 +/- 0.38.10(-2) mm Hg(-1) vs 3.69 +/- 1.96.10(-2) mm Hg(-1), p < 0.0001), and RAC was smaller (20 +/- 10% vs 58 +/- 21%, p < 0.0001) [mean +/- SD]. RAC showed an inverse curvilinear relation with mean pulmonary artery pressure (R2 = 0.47). Eighteen patients (26%) died because of cardiopulmonary causes. Patients with a pulmonary artery RAC 16% (log-rank p < 0.001). RAC predicted mortality better than area distensibility.CONCLUSION: Noninvasively measured pulmonary artery RAC predicts mortality in patients with PAH.

AB - AIMS: Decreased total compliance of the pulmonary vascular bed is associated with increased mortality in patients with pulmonary arterial hypertension (PAH). We investigated whether proximal pulmonary artery stiffness, in terms of area distensibility and noninvasively assessed relative area change (RAC), calculated as relative cross-sectional area change, predicts mortality in patients with PAH.METHODS AND RESULTS: Eighty-six subjects underwent right-heart catheterization and MRI to assess area distensibility and RAC. Patients were followed up to 48 months. Kaplan-Meier plot and Cox proportional hazards regression analyses assessed the predictive value of area distensibility and RAC. In 70 patients, the diagnosis PAH was confirmed, and 16 subjects served as control subjects. In comparison with control subjects, proximal pulmonary arteries of patients were distended (685 +/- 214 mm2 vs 411 +/- 153 mm2, p < 0.001), less distensible (area distensibility = 0.46 +/- 0.38.10(-2) mm Hg(-1) vs 3.69 +/- 1.96.10(-2) mm Hg(-1), p < 0.0001), and RAC was smaller (20 +/- 10% vs 58 +/- 21%, p < 0.0001) [mean +/- SD]. RAC showed an inverse curvilinear relation with mean pulmonary artery pressure (R2 = 0.47). Eighteen patients (26%) died because of cardiopulmonary causes. Patients with a pulmonary artery RAC 16% (log-rank p < 0.001). RAC predicted mortality better than area distensibility.CONCLUSION: Noninvasively measured pulmonary artery RAC predicts mortality in patients with PAH.

KW - Adult

KW - Cardiac Catheterization

KW - Case-Control Studies

KW - Elasticity

KW - Female

KW - Humans

KW - Hypertension, Pulmonary/mortality

KW - Least-Squares Analysis

KW - Magnetic Resonance Imaging

KW - Male

KW - Middle Aged

KW - Predictive Value of Tests

KW - Prognosis

KW - Proportional Hazards Models

KW - Pulmonary Artery/physiopathology

U2 - 10.1378/chest.07-1246

DO - 10.1378/chest.07-1246

M3 - Article

VL - 132

SP - 1906

EP - 1912

JO - Chest

JF - Chest

SN - 0012-3692

IS - 6

ER -