ArticleJournal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance
Characteristics and prognostic value of cardiovascular magnetic resonance imaging-derived left ventricular hemodynamics in pulmonary arterial hypertension.
Article in Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThere is increasing recognition of the importance of left ventricular (LV) assessment in pulmonary arterial hypertension (PAH). Hemodynamic patterns derived from hemodynamic force (HDF) analysis are an approach to evaluate hemodynamic patterns and myocardial dysfunction. However, its prognostic value with PAH remains unclear.
methodsPAH participants who underwent cardiac magnetic resonance (CMR) between January 2015 and July 2023 were prospectively and consecutively enrolled. LV HDF analysis was performed on the 2-, 3-, and 4-chamber long-axis view. The primary endpoint was all-cause mortality. Cox regression analysis and Kaplan-Meier survival analysis were performed to identify the association between parameters and outcomes. The incremental prognostic value of hemodynamic pattern and CMR scores were assessed using χ
resultsThere were 311 participants (mean age, 38 ± 14 years; 87 men) evaluated. During a median follow-up of 38 months (interquartile range, 16-54 months), 55 participants reached the primary endpoint. Full cardiac cycle (FCC) and diastolic deceleration impulse (DDI) HDF ratios, but not systolic ejection impulse, were significantly lower in PAH patients compared to healthy controls (P=0.003 and P=0.009, respectively). In multivariable Cox regression analysis, DDI HDF ratios were independent predictors of the primary endpoint in PAH patients and CHD-PAH subgroup (hazard ratio [HR], 0.83, [95% CI: 0.72, 0.96; P=0.009]; HR, 0.74, [95% CI: 0.56, 0.97; P=0.03]). Adding the DDI HDF ratio to established clinical models significantly improved risk classification, yielding a continuous NRI of 0.27 (P=0.01) and an IDI of 0.01 (P=0.03) for the overall cohort, with consistent improvements in the CHD-PAH subgroup (NRI 0.30, P=0.04; IDI 0.02, P=0.03).
conclusionLV hemodynamic patterns derived from CMR-based DDI HDF ratio were identified as independent prognostic predictor in pulmonary hypertension, providing incremental prognostic value beyond established risk scores.
trial registrationThis study was registered in the Chinese clinical trial registry (ChiCTR1800019314 and ChiCTR1900025518). URL: https://www.chictr.org.cn/.
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