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In patients with pulmonary arterial hypertension (PAH), Goh and colleagues1 hypothesised that adaptation of the right ventricle (RV) in response to chronic pressure overload would predict clinical outcome. Cardiac magnetic resonance (CMR) imaging in 505 patients in the ASPIRE registry (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre) was used to classify the pattern of RV remodelling. At a median of 4.85 years follow-up, 51% of patients died. Prognosis was best in the 181 patients with a relatively normal RV size and wall thickness (low-volume-low-mass) and most of these patients continued to have low-volume-low-mass on guideline-based medical therapy. In contrast the 74 patients with a high-volume-low-mass RV had the worst prognosis and were unlikely to show improvement in RV morphology even on treatment (figure 1).
In the accompanying editorial, D’Alto and Badagliacca2 discuss the relationship between PAH, RV remodelling, clinical symptoms and outcome. They go ono to propose that PAH patients with maladaptive RV remodelling might benefit from more aggressive initial medical therapy to reduce pulmonary vascular resistance, thus increasing the likelihood of reverse RV remodelling. In addition, they suggest that multicentre studies are needed to further elucidate the role of non-invasive imaging measures of RV morphology …
Contributors Heartbeat 108 Issue 17.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.