TY - JOUR AB - AimsWe sought to identify metabolic pathways associated with right ventricular (RV) adaptation to pulmonary hypertension (PH). We evaluated candidate metabolites, previously associated with survival in pulmonary arterial hypertension, and used automated image segmentation and parametric mapping to model their relationship to adverse patterns of remodelling and wall stress.Methods and resultsIn 312 PH subjects (47.1% female, mean age 60.8 ± 15.9 years), of which 182 (50.5% female, mean age 58.6 ± 16.8 years) had metabolomics, we modelled the relationship between the RV phenotype, haemodynamic state, and metabolite levels. Atlas-based segmentation and co-registration of cardiac magnetic resonance imaging was used to create a quantitative 3D model of RV geometry and function—including maps of regional wall stress. Increasing mean pulmonary artery pressure was associated with hypertrophy of the basal free wall (β = 0.29) and reduced relative wall thickness (β = −0.38), indicative of eccentric remodelling. Wall stress was an independent predictor of all-cause mortality (hazard ratio = 1.27, P = 0.04). Six metabolites were significantly associated with elevated wall stress (β = 0.28–0.34) including increased levels of tRNA-specific modified nucleosides and fatty acid acylcarnitines, and decreased levels (β = −0.40) of sulfated androgen.ConclusionUsing computational image phenotyping, we identify metabolic profiles, reporting on energy metabolism and cellular stress-response, which are associated with adaptive RV mechanisms to PH. AU - Attard,M AU - Dawes,T AU - Simoes,Monteiro de Marvao A AU - Biffi,C AU - Shi,W AU - Wharton,J AU - Rhodes,C AU - Ghataorhe,P AU - Gibbs,J AU - Howard,L AU - Rueckert,D AU - Wilkins,M AU - O'Regan,D DO - ehjci/jey175 EP - 676 PY - 2019/// SN - 2047-2412 SP - 668 TI - Metabolic pathways associated with right ventricular adaptation to pulmonary hypertension: Three dimensional analysis of cardiac magnetic resonance imaging T2 - EHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging UR - http://dx.doi.org/10.1093/ehjci/jey175 UR - http://hdl.handle.net/10044/1/65817 VL - 20 ER -