Key result
Novel MRI model accurately estimates invasive right atrial pressure within ~2.8 mmHg.
Why the study?
Right atrial pressure is a key determinant of right-sided heart function, but reliable non-invasive estimation remains difficult.
Does an MRI-based model incorporating abdominal venous and hepatic tissue biomarkers accurately predict invasively measured right atrial pressure in adults?
Observational (n=181)
No
Does an MRI-based model incorporating abdominal venous and hepatic tissue biomarkers accurately predict invasively measured right atrial pressure in adults?
A four-variable MRI model combining IVC diameter, liver T1 relaxation time, right atrial area, and body weight provides a highly accurate and well-calibrated non-invasive estimation of right atrial pressure.
Hypothesis-generating for non-invasive RAP estimation by MRI; prospective validation needed before clinical adoption.
AIMS: Right atrial pressure (RAP) is a key determinant of right-sided heart function and guides diagnosis and management across a wide range of cardiovascular diseases. However, reliable non-invasive estimation remains difficult. We aimed to develop and validate a magnetic resonance imaging (MRI)-based model for predicting invasive RAP. METHODS AND RESULTS: This study included 181 adults who underwent clinically indicated MRI and right heart catheterization within 48 h between 2016 and 2025. The sample was split into a development (N = 125) and an independent held-out test-set cohort (N = 56) stratified by RAP category. Generalized additive models and systematic transformation screening were used to characterize non-linear predictor-outcome associations. Predictors were selected using pre-defined criteria (ΔAkaike information criterion ≥ 2, partial R2 ≥ 0.02, least absolute shrinkage and selection operator [LASSO] bootstrap inclusion ≥90%, physiological plausibility). The final model included inferior vena cava expiratory diameter (linear and quadratic terms), liver T1 relaxation time (linear and quadratic terms), right atrium area (linear), and body weight (linear). In the development cohort, performance was strong (adjusted R2 = 0.698; residual standard deviation 2.58 mmHg) and remained consistent across three internal validation approaches. Held-out test-set validation showed an R2 of 0.621, a root-mean-square error of 2.78 mmHg, a mean absolute error of 2.07 mmHg, and a concordance coefficient of 0.777. Calibration in the testing set was excellent (intercept + 0.18, slope = 0.92; integrated calibration index 0.65 mmHg). Discrimination for elevated RAP was high with area under the curves of 0.749 (>5 mmHg), 0.949 (>10 mmHg), and 0.965 (>15 mmHg). CONCLUSION: An MRI model incorporating abdominal venous and hepatic tissue biomarkers provides a clinically useful, well-calibrated approach for estimating invasive RAP.
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Eynde et al. (2026) conducted an observational in Cardiovascular diseases requiring right heart catheterization (n=181). MRI-based prediction model (IVC expiratory diameter, liver T1 relaxation time, RA area, body weight) vs. Invasive right heart catheterization (reference standard) was evaluated on Prediction of invasive right atrial pressure (RAP) in a held-out test set (R2 0.621). An MRI-based model incorporating abdominal venous and hepatic tissue biomarkers accurately estimated invasive right atrial pressure with an R2 of 0.621 and a root-mean-square error of 2.78 mmHg in an independent test set.
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