Exercise Performance in Patients with Pulmonary Hypertension Linked to Cardiac Magnetic Resonance Measures

OBJECTIVES: The 6-minute walk distance (6MWD) is a useful measure of functional class and has been shown to predict mortality in patients with pulmonary hypertension (PH). Determinants of functional class in PH are incompletely understood. We hypothesized that cardiovascular structure and function, as determined by cardiac magnetic resonance (CMR) imaging, and cardiac hemodynamics, as determined by right heart catheterization (RHC), would predict 6MWD in adult patients with PH.

METHODS: Forty-three patients (32 women) with PH underwent RHC, CMR and 6MWD testing within a 3-month period. The 6MWD was correlated with RHC and CMR variables using Spearman rho (r) coefficients. These relationships were further evaluated using linear regression analysis.

RESULTS: Median 6MWD was 233.2 (interquartile range 161.6 to 338.4) meters. The 6MWD was correlated with pulmonary artery (PA) elasticity (r = 0.42, p = 0.006), PA average blood flow velocity (r = 0.38, p = 0.014), right ventricular stroke volume index (RVSVI; r = 0.41, p = 0.008), left ventricular SVI (LVSVI; r = 0.36, p = 0.018) and RV stroke work index (RVSWI; r = 0.37, p = 0.017). These associations remained significant after adjustment for age, gender, body mass index and the presence of lung disease. Exercise performance did not correlate with commonly measured indices such as ventricular volume, ejection fraction or pulmonary pressure.

CONCLUSIONS: Stroke volume index, PA elasticity and PA average blood flow velocity are novel CMR parameters associated with functional class in PH. CMR can provide insights into determinants of exercise performance and may be a useful tool to non-invasively monitor cardiovascular status in patients with PH.

PMID: 19716042

Jacobo Kirsch

Associate Center Director, Imaging Institute
Cardiopulmonary Imaging, Section Head
Cleveland Clinic Florida
Weston, FL
Posted in Magnetic Resonance Imaging and tagged , , .

2 Comments

  1. This study in 43 patients reinforces the utility of MR as a tool to assess the adaptive processes of the RV and pulmonary artery under pathological stresses.
    The study found that, as observed in prior studies, RV EF and mean PA pressure do not correlate well with exercise performance. Instead, they found the stronger association to be between PA elasticity, PA average velocity, stroke volume and stroke work indices.
    These findings may help in diagnosing pulmonary hypertension in its earliest stages.

  2. Unfortunately the 6 min walk depends on a great many factors, making it not an infallible reflection of cardiac function.

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