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Volume 18 Supplement 1

19th Annual SCMR Scientific Sessions

  • Poster presentation
  • Open Access

Right atrial volume measured by cardiac magnetic resonance correlates with NT-ProBNP and invasive right atrial pressure in pulmonary hypertension, with and without systemic sclerosis

  • 1, 2,
  • 1, 3,
  • 1, 2,
  • 4, 2,
  • 5, 2,
  • 1, 2 and
  • 1, 2
Journal of Cardiovascular Magnetic Resonance201618 (Suppl 1) :P300

https://doi.org/10.1186/1532-429X-18-S1-P300

  • Published:

Keywords

  • Pulmonary Hypertension
  • Body Surface Area
  • Cardiac Magnetic Resonance
  • Systemic Sclerosis
  • Atrial Pressure

Background

Right atrial (RA) pressure (RAP) and NT-ProBNP-levels are important prognostic factors in pulmonary hypertension (PH). The aim of this study was to investigate if RA volume (RAV), emptying fraction and emptying volume measured with cardiac magnetic resonance (CMR) can be used to predict RAP, and to investigate if these measures are related to NT-ProBNP levels. Furthermore, we aimed to determine if RAV in systemic sclerosis patients with precapillary PH (PHSSc) differs from PH patients without systemic sclerosis (PHnonSSc).

Methods

We included 27 patients with PH (54 ± 19 years, 18 women). PH was defined as mPAP ≥25 mmHg and PCWP ≤15 mmHg at normal or reduced cardiac output. 11 patients with and 16 patients without Systemic Sclerosis and 35 healthy controls (age 31 ± 9 years, 16 women) underwent cine CMR to quantify end-systolic maximum (RAVmax) and end-diastolic minimum (RAVmin) right atrial volume indexed to body surface area. Invasive pressures were measured with right heart catheterization and plasma NT-ProBNP level from venous blood samples.

Results

In all PH patients (PHSSc and PHnonSSc) mRAP was 7 ± 6 mmHg, sPAP 73 ± 23 mmHg, mPAP 46 ± 16 mmHg and PCWP 8 ± 4 mmHg. The correlation coefficient (r) between mRAP and RAVmin was 0.46 (p=0.015) and between mRAP and RAVmax 0.43 (p=0.024). Mean NT-ProBNP was 1894 ± 2381 ng/L. In the PH patients, mRAP correlated with NT-ProBNP (r = 0.5, p = 0.019). There was a strong correlation between NT-ProBNP and RAVmin (r = 0.7, p = 0.0003) and RAVmax (r = 0.67, p = 0.0006).

RAVmin in patients with PHnonSSc (97 ± 35 ml/m2) was higher as compared to PHSSc (54 ± 23 ml/m2, p < 0.05) and healthy controls (57 ± 12 ml/m2, p < 0.05), but did not differ between patients with PHSSc and healthy controls (NS). There was also a significant difference in RAVmax between the patients with PHnonSSc (69 ± 32 ml/m2) and PHSSc (32 ± 19 ml/m2, p < 0.05) as well as healthy controls (24 ± 8 ml/m2, p < 0.05), yet no difference between PHSSc and healthy controls (NS). RA emptying fraction differed between the PHnonSSc patients and the healthy controls (31 ± 12% vs. 54 ± 15%, p < 0.05), but neither between PHSSc patients (43 ± 18%) and healthy controls nor PH patients (ns). There was no significant difference in RA emptying volume between the groups PHnonSSc (29 ± 13 ml/m2), PHSSc (21 ± 11 ml/m2) and the healthy controls (31 ± 10 ml/m2).

Conclusions

This study shows that non-invasive measures of right atrial volumes by cardiac magnetic resonance correlates with NT-ProBNP and invasive right atrial pressure in patients with precapillary PH. Furthermore, RAVmin and RAVmax were increased in PHnonSSc compared to PHSSc. Future studies are needed to investigate the clinical advantages of these complementary measures in the diagnostics of pulmonary hypertension.
Figure 1
Figure 1

The left panel shows the minimum right atrial volume (RAV min ) compared to invasive mean right atrial pressure (mRAP), the right panel shows the RAV min compared to NT-ProBNP.

Figure 2
Figure 2

Tukey boxplots of right atrial minimum volume (RAV min ) and maximum volume (RAV max ) in patients with precapillary PH without (PH nonSSc ) and with Systemic Sclerosis (PH SSc ) as well as in healthy controls.

Authors’ Affiliations

(1)
Dept of Clinical Physiology, Cardiac MR Group, Lund, Sweden, Sweden
(2)
Department of Clinical Sciences Lund, Lund University, and Lund University Hospital, Lund, Sweden
(3)
Department of Health Sciences, Lund University, Physiotherapy, Lund, Sweden
(4)
The Section for Heart Failure and Valvular Disease, Lund, Sweden
(5)
Department of Rheumatology, Lund, Sweden

Copyright

© Gyllenhammar et al. 2016

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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