• van der BruggenCathelijne EmmaCEPulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Martin Louis Handoko, Harm Jan Bogaard, Johannes Timotheus Marcus, OosterveerFranciscus Petrus TheodorusFPTPulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Lilian Jacoba Meijboom, Berend Eric Westerhof, Anton Vonk Noordegraaf, and Frances S de Man.
• Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
• Chest. 2021 Apr 1; 159 (4): 1575-1585.

BackgroundTreatment of patients with pulmonary arterial hypertension (PAH) is conventionally based on functional plus invasive measurements obtained during right heart catheterization (RHC). Whether risk assessment during repeated measurements could also be performed on the basis of imaging parameters is unclear, as a direct comparison of strategies is lacking.Research QuestionHow does the predictive value of noninvasive parameters compare with that of invasive hemodynamic measurements 1 year after the diagnosis of idiopathic PAH?Study Design And MethodsOne hundred and eighteen patients with idiopathic PAH who underwent RHC and cardiac MRI (CMR) were included in this study (median time between baseline evaluation and first parameter measures, 1.0 [0.8-1.2] years). Forty-four patients died or underwent lung transplantation. Forward Cox regression analyses were done to determine the best predictive functional, hemodynamic, and/or imaging model. Patients were classified as high risk if the event occurred < 5 years after diagnosis (n = 24), whereas patients without event were classified as low risk.ResultsA prognostic model based on age, sex, and absolute values at follow-up of functional parameters (6-min walk distance) performed well (Akaike information criterion [AIC], 279; concordance, 0.67). Predictive models with only hemodynamic (right atrial pressure, mixed venous oxygen saturation; AIC, 322; concordance, 0.66) or imaging parameters (right ventricular ejection fraction; AIC, 331; concordance, 0.63) at 1 year of follow-up performed similarly. The predictive value improved when functional data were combined with either hemodynamic data (AIC, 268; concordance, 0.69) or imaging data (AIC, 273; concordance, 0.70). A model composed of functional, hemodynamic, and imaging data performed only marginally better (AIC, 266; concordance, 0.69). Finally, changes between baseline and 1-year follow-up were observed for multiple hemodynamic and CMR parameters; only a change in CMR parameters was of prognostic predictive value.InterpretationAt 1 year of follow-up, risk assessment based on CMR is at least equal to risk assessment based on RHC. In this study, only changes in CMR, but not hemodynamic parameters, were of prognostic predictive value during the first year of follow-up.Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

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