Title
Prognostic Value of Pulmonary Transit Time and Pulmonary Blood Volume Estimation Using Myocardial Perfusion CMR
Date Issued
01 November 2021
Access level
open access
Resource Type
journal article
Author(s)
Seraphim A.
Knott K.D.
Augusto J.B.
Davies R.
Pierce I.
Joy G.
Bhuva A.N.
Xue H.
Treibel T.A.
Cooper J.A.
Petersen S.E.
Fontana M.
Hughes A.D.
Moon J.C.
Manisty C.
Kellman P.
University College London
Publisher(s)
Elsevier Inc.
Abstract
Objectives: The purpose of this study was to explore the prognostic significance of PTT and PBVi using an automated, inline method of estimation using CMR. Background: Pulmonary transit time (PTT) and pulmonary blood volume index (PBVi) (the product of PTT and cardiac index), are quantitative biomarkers of cardiopulmonary status. The development of cardiovascular magnetic resonance (CMR) quantitative perfusion mapping permits their automated derivation, facilitating clinical adoption. Methods: In this retrospective 2-center study of patients referred for clinical myocardial perfusion assessment using CMR, analysis of right and left ventricular cavity arterial input function curves from first pass perfusion was performed automatically (incorporating artificial intelligence techniques), allowing estimation of PTT and subsequent derivation of PBVi. Association with major adverse cardiovascular events (MACE) and all-cause mortality were evaluated using Cox proportional hazard models, after adjusting for comorbidities and CMR parameters. Results: A total of 985 patients (67% men, median age 62 years [interquartile range (IQR): 52 to 71 years]) were included, with median left ventricular ejection fraction (LVEF) of 62% (IQR: 54% to 69%). PTT increased with age, male sex, atrial fibrillation, and left atrial area, and reduced with LVEF, heart rate, diabetes, and hypertension (model r2 = 0.57). Over a median follow-up period of 28.6 months (IQR: 22.6 to 35.7 months), MACE occurred in 61 (6.2%) patients. After adjusting for prognostic factors, both PTT and PBVi independently predicted MACE, but not all-cause mortality. There was no association between cardiac index and MACE. For every 1 × SD (2.39-s) increase in PTT, the adjusted hazard ratio for MACE was 1.43 (95% confidence interval [CI]: 1.10 to 1.85; p = 0.007). The adjusted hazard ratio for 1 × SD (118 ml/m2) increase in PBVi was 1.42 (95% CI: 1.13 to 1.78; p = 0.002). Conclusions: Pulmonary transit time (and its derived parameter pulmonary blood volume index), measured automatically without user interaction as part of CMR perfusion mapping, independently predicted adverse cardiovascular outcomes. These biomarkers may offer additional insights into cardiopulmonary function beyond conventional predictors including ejection fraction.
Start page
2107
End page
2119
Volume
14
Issue
11
Language
English
OCDE Knowledge area
Sistema cardiaco, Sistema cardiovascular
Subjects
Scopus EID
2-s2.0-85107272142
PubMed ID
Source
JACC: Cardiovascular Imaging
ISSN of the container
1936-878X
Sponsor(s)
This study was supported by a Clinical Training Research Fellowship (to Dr. Seraphim) from the British Heart Foundation (FS/18/83/34025) and directly and indirectly from the National Institute for Health Research Biomedical Research Centres at University College London Hospitals and Barts Health National Health Service Trusts. This study was also supported by the National Heart, Lung and Blood Institute, National Institutes of Health by the Division of Intramural Research (Z1A- HL006214-05 and Z1A- HL006242-02). This work forms part of the research areas contributing to the translational research portfolio of the Biomedical Research Centre at Barts, which is supported and funded by the National Institute for Health Research. Prof. Petersen has served as a consultant for and is a shareholder of Circle Cardiovascular Imaging Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Sources of information:
Directorio de Producción Científica
Scopus