Fractal analysis of right ventricular trabeculae in pulmonary hypertension

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Title: Fractal analysis of right ventricular trabeculae in pulmonary hypertension
Authors: Dawes, T
Cai, J
Quinlan, M
Simoes Monteiro de Marvao, A
Ostowski, P
Tokarczuk, P
Watson, G
Wharton, J
Howard, L
Gibbs, J
Cook, S
Wilkins, M
O'Regan, DP
Item Type: Journal Article
Abstract: Purpose: To measure right ventricular (RV) trabecular complexity by its fractal dimension (FD) in healthy subjects and patients with pulmonary hypertension (PH) and assess its relationship to hemodynamic and functional parameters, and future cardiovascular events. Materials and methods: This retrospective study used data acquired from May 2004 to October 2013 for 256 patients with newly-diagnosed PH that underwent cardiac magnetic resonance (CMR) imaging, right heart catheterization and six-minute walk distance testing with a median follow-up of 4.0 years. 256 healthy controls underwent CMR only. Biventricular FD, volumes and function were assessed on short-axis cine images. Reproducibility was assessed by intraclass correlation coefficient, correlation between variables was assessed by Pearson’s correlation test, and mortality prediction compared by univariable and multivariable Cox regression analysis. Results: RV-FD reproducibility had an intraclass correlation coefficient of 0.97 (95% confidence interval [CI]: 0.96, 0.98). RV-FD was higher in PH patients than healthy subjects (median 1.310, inter-quartile range [IQR] 1.281-1.341 vs 1.264, 1.242-1.295, P <.001) with the greatest difference near the apex. RV-FD was associated with pulmonary vascular resistance (r=0.30, P <.001). In univariable Cox regression analysis, RV-FD was a significant predictor of death (hazards ratio [HR]: 1.256, CI: 1.011, 1.560, P =.04), but in a multivariable analysis did not predict survival independently of conventional parameters of RV remodeling (HR: 1.179, CI: 0.871, 1.596, P =0.29). Conclusion: Fractal analysis of RV trabecular complexity is a highly reproducible measure of remodeling in PH associated with afterload, although the gain in survival prediction over traditional markers is not significant.
Issue Date: 1-Aug-2018
Date of Acceptance: 6-Mar-2018
ISSN: 0033-8419
Publisher: Radiological Society of North America
Start Page: 386
End Page: 395
Journal / Book Title: Radiology
Volume: 288
Issue: 2
Copyright Statement: © The Author(s). Published under a CC BY 4.0 license (
Sponsor/Funder: Imperial College Healthcare NHS Trust- BRC Funding
The Academy of Medical Sciences
Imperial College London
Imperial College Healthcare NHS Trust- BRC Funding
British Heart Foundation
Imperial College Healthcare NHS Trust- BRC Funding
Funder's Grant Number: RD410
Keywords: 11 Medical And Health Sciences
Nuclear Medicine & Medical Imaging
Publication Status: Published
Online Publication Date: 2018-06-05
Appears in Collections:Clinical Sciences
Imaging Sciences
National Heart and Lung Institute
Molecular Sciences
Department of Medicine (up to 2019)
Faculty of Medicine

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