Capener, D.

Condliffe, R.

Elliot, C.

Hussain, N.

Kiely, D.G.

Swift, A.

Wild, J.M.

Journal of Cardiovascular Magnetic Resonance

PubMed

Nehal Hussain

David Capener

Charlie Elliot

Robin Condliffe

Jim M Wild

David G Kiely

Andrew Swift

Crossref

Interventricular septal angle can be used to predict which patients have combined postcapillary or precapillary pulmonary hypertension in left heart disease

White Rose Research Online

POSTER PRESENTATION Open AccessInterventricular septal angle can be used topredict which patients have combinedpostcapillary or precapillary pulmonaryhypertension in left heart diseaseNehal Hussain1,2*, David Capener2,1, Charlie Elliot1, Robin Condliffe1, Jim M Wild2, David G Kiely1, Andrew Swift2,1From 18th Annual SCMR Scientific SessionsNice, France. 4-7 February 2015BackgroundA transpulmonary gradient (TPG)>12mmHg is thought torepresent evidence of vascular change beyond thatexpected from passive pulmonary venous congestion inpatients with pulmonary hypertension and left heart dis-ease (PH-LHD). However recent studies found those witha diastolic pressure gradient (DPG) >6 to have a worsesurvival. This has led to a change in the recent guidelinessuggesting 2 types of PH-LHD: “isolated post-capillaryPH” (pulmonary arterial wedge pressure (PAWP)>15 mmHg and DPG<7mmHg) and “combined postcapillary PHand pre-capillary PH” (PAWP>15 mm Hg and DPG≥7mmHg).It would be advantageous if a non-invasive method ofpredicting DPG could be found for both prognosticationand to identify potential patients for clinical trials of tar-geted therapies. Our aim was investigate the utility ofcardiac magnetic resonance (CMR) imaging for estima-tion of DPG in patients with PH-LHD.MethodsPatients with suspected pulmonary hypertension under-went CMR imaging at our unit between April 2012 andApril 2014. Classification followed systematic evaluationwith multimodality imaging and right heart catheterisation(RHC). Patients were diagnosed as PH-LHD if no othercauses of PH could be identified and they fulfilled the fol-lowing criteria: signs and symptoms of heart failure; meanpulmonary artery pressure (mPAP) ≥25mmHg at rest andpulmonary arterial wedge pressure >15mmHg by RHC.TPG was defined mPAP-PAWP, and DPG was defined asdiastolic PAP-PAWP.A number of parameters were analysed including:right and left ventricular indexed volumes, ejection frac-tions and mass; aortic and pulmonary flow, pulmonaryarterial area, and the inter-ventricular septal angle insystole and diastole.Results89 patients where found to have a diagnosis of PH-LHD.The average age was 70yrs with 58% being female. Ofthese 89 patients, 67% were found to have aTPG>12mmHg, but only 26% had a DPG >6mmHg. Nopatients were found to have a raised TPG, but normalDPG. The average mPAP=44mmHg (SD±11),TPG=23mmHg (SD±11), and DPG=5 (SD±9). Systolicseptal angle was the only CMR marker with a significantassociation with DPG, (r=0.69, p<0.0001). Receiver operat-ing characteristics (ROC) curve of systolic septal angleagainst DPG>6mmHg yielded an area under the curve(AUC) of 0.87. ROC curve analysis established a systolicseptal angle of >135o to be the optimal threshold for dis-tinguishing a normal DPG from those with aDPG>6mmHg (sensitivity 100%, specificity 79%). In addi-tion linear regression was used to derive coefficients toallow formulation of an equation estimating DPG fromsystolic septal angle: DPG=0.359xsystolic septal angle-51.ConclusionsSystolic septal angle can be used to estimate whether apatient has “isolated post-capillary” or “combined post-capillary and pre-capillary” PH.1Sheffield Pulmonary Vascular Diseases Unit, Hallamshire Hospital, Sheffield,UKFull list of author information is available at the end of the articleHussain et al. Journal of Cardiovascular MagneticResonance 2015, 17(Suppl 1):P338http://www.jcmr-online.com/content/17/S1/P338© 2015 Hussain et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.FundingNone.Authors’ details1Sheffield Pulmonary Vascular Diseases Unit, Hallamshire Hospital, Sheffield,UK. 2Academic Radiology, Sheffield University, Sheffield, UK.Published: 3 February 2015doi:10.1186/1532-429X-17-S1-P338Cite this article as: Hussain et al.: Interventricular septal angle can beused to predict which patients have combined postcapillary orprecapillary pulmonary hypertension in left heart disease. Journal ofCardiovascular Magnetic Resonance 2015 17(Suppl 1):P338.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitFigure 1Figure 2Hussain et al. Journal of Cardiovascular MagneticResonance 2015, 17(Suppl 1):P338http://www.jcmr-online.com/content/17/S1/P338Page 2 of 2

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https://eprints.whiterose.ac.uk/124450/1/Interventricular%20septal%20angle%20can%20be%20used%20to%20predict%20which%20patients%20have%20combined%20postcapillary%20or%20precapillary%20pulmonary%20hypertension%20in%20left%20heart%20disease.pdf

Interventricular septal angle can be used to predict which patients have combined postcapillary or precapillary pulmonary hypertension in left heart disease

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