Key result
Higher MRI-derived diastolic deceleration impulse hemodynamic force ratio predicts ~17% lower event risk in PAH.
Why the study?
Although left ventricular assessment is increasingly recognized as important in pulmonary arterial hypertension, the prognostic value of hemodynamic force analysis in PAH remains unclear.
Does MRI-derived left ventricular diastolic deceleration impulse (DDI) hemodynamic force ratio predict outcomes in patients with pulmonary arterial hypertension?
Cohort (n=311)
Does MRI-derived left ventricular diastolic deceleration impulse (DDI) hemodynamic force ratio predict outcomes in patients with pulmonary arterial hypertension?
Answers are grounded in this paper and cite their sources.
CMR-derived left ventricular diastolic deceleration impulse hemodynamic force ratio provides independent and incremental prognostic value beyond established risk scores in patients with pulmonary arterial hypertension.
BACKGROUND: There is increasing recognition of the importance of left ventricular (LV) assessment in pulmonary arterial hypertension (PAH). Hemodynamic patterns derived from hemodynamic force (HDF) analysis is an approach to evaluate hemodynamic patterns and myocardial dysfunction. However, its prognostic value with PAH remains unclear. METHODS: test, net reclassification improvement (NRI) and integrated discrimination improvement (IDI). RESULTS: There 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). CONCLUSION: LV 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 REGISTRATION: This study was registered in the Chinese clinical trial registry (ChiCTR1800019314 and ChiCTR1900025518). URL: https://www.chictr.org.cn/.
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Wang et al. (2026) conducted a cohort in Pulmonary Arterial Hypertension (n=311). MRI-derived diastolic deceleration impulse (DDI) hemodynamic force ratio vs. Established clinical models was evaluated on Primary endpoint (not explicitly defined) (HR 0.83, 95% CI 0.72-0.96, p=0.009). MRI-derived diastolic deceleration impulse hemodynamic force ratio was an independent predictor of the primary endpoint in PAH patients (HR 0.83; 95% CI 0.72-0.96; P=0.009).
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