Key result
An abnormal RV/LV volume ratio (≥1.27) on cardiac MRI was associated with a higher risk of mortality and heart failure hospitalizations in pulmonary hypertension (HR 1.81; 95% CI 1.06-2.97; p=0.003).
Why the study?
Noninvasive tools for early detection and risk stratification in pulmonary hypertension are limited, and the prognostic utility of the cardiac MRI-derived RV to LV volume ratio remains underexplored.
Does an abnormal RV/LV volume ratio on cardiac MRI predict all-cause mortality and heart failure hospitalizations in patients with pulmonary hypertension?
Cohort (n=135)
Does an abnormal RV/LV volume ratio on cardiac MRI predict all-cause mortality and heart failure hospitalizations in patients with pulmonary hypertension?
Hazard Ratio: 1.81 (95% CI 1.06–2.97)
Absolute Event Rate: 64.3% vs 50%
p-value: p=0.003
An abnormal RV/LV volume ratio (≥1.27) on cardiac MRI is a simple prognostic marker that independently predicts mortality and heart failure hospitalizations in patients with pulmonary hypertension.
RV/LV vol ratio may enhance PH risk stratification on CMR; supports validation in larger prospective cohorts before practice change.
Right ventricular (RV) performance impacts clinical outcomes across pulmonary hypertension (PH), yet noninvasive tools for early detection and risk stratification are limited. Cardiac MRI (CMR) derived RV to left ventricular (LV) volume ratio (RV/LV vol ratio) provides a relative assessment of RV size by normalizing chamber size to the LV. However, its prognostic utility remains underexplored. In the present study, we investigate the association between the RV/LV vol ratio and outcomes in patients with PH. This prospective study included patients with PH (pulmonary arterial systolic pressure > 35 mmHg by echocardiography or mean pulmonary artery pressure > 20 mmHg on invasive right heart catheterization), who underwent CMR. Abnormal RV/LV vol ratio cutoff (≥1.27) was applied and further tested using established gradation thresholds. The primary outcome was a composite of all-cause mortality and heart failure hospitalizations. Of 135 patients, 56 (41.5 %) had an abnormal RV/LV vol ratio. After a mean follow-up of 1.9 ± 1.3 years, 75 patients experienced the primary outcome. Patients with an abnormal RV/LV vol ratio had higher rates of the primary outcome (64.3 % vs 50.0 %, p = 0.02). After multivariable analysis adjusting for age and CMR indices, abnormal RV/LV vol ratio was independently associated with the primary outcome (HR 1.81 [95 % CI 1.06–2.97]; p = 0.003). RV/LV vol ratio added incremental prognostic value over age and traditional RV indices (global χ2 value increasing from 6.7 to 17.4, p = 0.006). The RV/LV vol ratio is a simple clinical tool associated with an increased risk of adverse outcomes in PH patients, offering prognostic information beyond traditional RV parameters.
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Zhang et al. (2025) conducted a cohort in Pulmonary hypertension (n=135). Abnormal RV/LV volume ratio (≥1.27) vs. Normal RV/LV volume ratio (<1.27) was evaluated on Composite of all-cause mortality and heart failure hospitalizations (HR 1.81, 95% CI 1.06-2.97, p=0.003). An abnormal RV/LV volume ratio (≥1.27) on cardiac MRI was associated with a higher risk of mortality and heart failure hospitalizations in pulmonary hypertension (HR 1.81; 95% CI 1.06-2.97; p=0.003).
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