Researchers discovered that low left and right atrioventricular plane displacement (AVPD) could be a useful prognostic indicator for patients with pulmonary arterial hypertension (PAH) and published their results in The International Journal of Cardiovascular Imaging.
PAH usually leads to right heart failure, causing early mortality. Presently, cardiac magnetic resonance imaging (CMR) remains the most effective method for assessing ventricular volumes and global function. This is especially true for the right side of the heart.
Studies indicate that a reduced stroke volume is a prognostic factor for poorer outcomes in PAH. Ventricular stroke volume is determined by 2 factors: radial contraction and longitudinal shortening. The longitudinal component (SV [stroke volume]long%) can be quantified from AVPD; it is the major contributor to stroke volume in both the left and right ventricles in healthy patients.
Other known prognostic factors for PAH with CMR are reduced right ventricular ejection fraction, increased right ventricular volume, and reduced left ventricular volume.
Read more about PAH prognosis
“The aim of this study was to investigate if regional longitudinal and radial markers of biventricular function have prognostic implications in patients with PAH,” the authors wrote.
To carry out this study, they recruited 71 patients diagnosed with PAH who underwent CMR and right heart catheterization. They calculated metrics such as AVPD, SVlong%, lateral contribution to SV (SVlat%), and septal contribution to SV (SVsept%). Statistical analysis was then performed.
“The main finding of this study was that low AVPD in both ventricles were associated with increased risk of lung transplantation and death in patients with PAH,” Lindholm and colleagues wrote. The risk of these outcomes was associated with the magnitudes of AVPD. Regional contributions to stroke volume and ejection fraction were found to not be associated with PAH clinical outcomes.
The significance of this study is that AVPD measured with cardiac magnetic resonance imaging can be used to assess disease progress and risk in PAH care.
Lindholm A, Kjellström B, Seemann F, et al. Atrioventricular plane displacement and regional function to predict outcome in pulmonary arterial hypertension. Int J Cardiovasc Imaging. Published online April 23, 2022. doi:10.1007/s10554-022-02616-w