Key result
In patients with pulmonary arterial hypertension, every 1% decrease in right ventricular ejection fraction on cardiac MRI was associated with a 4.9% increased risk of clinical worsening.
Why the study?
CMR has known prognostic value in PAH, but data were limited regarding its ability to predict clinical worsening.
Do cardiac magnetic resonance (CMR) parameters predict clinical worsening and mortality in patients with pulmonary arterial hypertension?
Meta-Analysis (n=1,938)
Do cardiac magnetic resonance (CMR) parameters predict clinical worsening and mortality in patients with pulmonary arterial hypertension?
Cardiac magnetic resonance parameters, particularly right ventricular function and volumes, are strong predictors of clinical worsening and mortality in patients with pulmonary arterial hypertension.
Answers are grounded in this paper and cite their sources.
CMR RV parameters should inform PAH risk stratification; extends prior mortality data to confirm clinical worsening prediction.
This meta-analysis evaluates assessment of pulmonary arterial hypertension (PAH), with a focus on clinical worsening and mortality. Cardiac magnetic resonance (CMR) has prognostic value in the assessment of patients with PAH. However, there are limited data on the prediction of clinical worsening, an important composite endpoint used in PAH therapy trials. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Web of Science databases were searched in May 2020. All CMR studies assessing clinical worsening and the prognosis of patients with PAH were included. Pooled hazard ratios of univariate regression analyses for CMR measurements, for prediction of clinical worsening and mortality, were calculated. Twenty-two studies with 1,938 participants were included in the meta-analysis. There were 18 clinical worsening events and 8 deaths per 100 patient-years. The pooled hazard ratios show that every 1% decrease in right ventricular (RV) ejection fraction is associated with a 4.9% increase in the risk of clinical worsening over 22 months of follow-up and a 2.1% increase in the risk of death over 54 months. For every 1 ml/m2 increase in RV end-systolic volume index or RV end-diastolic volume index, the risk of clinical worsening increases by 1.3% and 1%, respectively, and the risk of mortality increases by 0.9% and 0.6%. Every 1 ml/m2 decrease in left ventricular stroke volume index or left ventricular end-diastolic volume index increased the risk of death by 2.5% and 1.8%. Left ventricular parameters were not associated with clinical worsening. This review confirms CMR as a powerful prognostic marker in PAH in a large cohort of patients. In addition to confirming previous observations that RV function and RV and left ventricular volumes predict mortality, RV function and volumes also predict clinical worsening. This study provides a strong rationale for considering CMR as a clinically relevant endpoint for trials of PAH therapies.
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Alabed et al. (2020) conducted a meta-analysis in Pulmonary arterial hypertension (n=1,938). Cardiac magnetic resonance (CMR) measurements was evaluated on Clinical worsening (4.9% increase in risk per 1% decrease in RV ejection fraction). In patients with pulmonary arterial hypertension, every 1% decrease in right ventricular ejection fraction on cardiac MRI was associated with a 4.9% increased risk of clinical worsening.
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