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13-02-2015 | Pulmonary hypertension | Article

Radionuclide angiography-assessed RVEF predicts PAH outcomes

medwireNews: Baseline right ventricular ejection fraction (RVEF) as evaluated by conventional planar equilibrium radionuclide angiography (ERNA) is significantly associated with outcomes in patients with pulmonary arterial hypertension (PAH), research suggests.

Additionally, the change in RVEF at 3 to 6 months after initiation of PAH treatment also predicts outcome, report Vincent Cottin (Hôpital Louis Pradel, Lyon, France) and colleagues in the European Respiratory Journal.

Of the 100 patients with idiopathic, heritable or anorexigen-associated PAH, cardiovascular survival was significantly improved in individuals with a median baseline RVEF of at least 25% compared with those who had an RVEF less than 25%, with 5-year rates of 70.5% and 47.1%, respectively.

A similar significant improvement was also observed for 8-year all-cause survival in participants with an RVEF of at least 25%, at 69.1% versus 42.3% in those with an RVEF lower than 25%.

Moreover, the 5-year cardiovascular survival was 88.0% in the 72% of participants who had a stable or increased RVEF at 3 to 6 months following PAH therapy initiation and 65.9% in those with a decreased RVEF, a difference that was statistically significant. But participants in the former group only showed a trend towards better all-cause survival.

RVEF also predicted mortality in patients who seemed to have preserved systolic function as signified by normal tricuspid annular plane systolic excursion (TAPSE) values on transthoracic echocardiography, leading the researchers to conclude that planar ERNA-assessed RVEF is useful for evaluating long-term prognosis in this patient population.

Highlighting the advantages of planar ERNA compared with cardiac magnetic resonance imaging, such as the reproducibility, reasonable cost and wide availability, they propose that the technique could be a “valuable alternative” to assess RV function in PAH patients, but say that irradiation-related risks should be considered, especially in younger patients.

In a linked editorial, Robert Naeije (Erasme University Hospital, Brussels, Belgium) and Stefano Ghio (Fondazione IRCCS Policlinico San Matteo, Pavia, Italy) question the proposed “brighter future” of radionuclide RVEF in PAH.

They point out that “the procedure requires appointments at specialised departments, with possible waiting lists”, and add that it is important that RV function be assessed regularly for PAH patients of all ages without concerns of radiation-associated risks.

By Shreeya Nanda

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