Work

Cardiac MRI-derived ventricular-pulmonary arterial coupling predicts outcomes in connective tissue disease-associated pulmonary arterial hypertension patients

Year: 2025

Type: article

Abstract: Objectives: To evaluate the prognostic value of cardiovascular magnetic resonance (CMR) parameters in patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH). Materials and methods: This retrospective cohort study involved 135 patients with documented CTD-PAH. Cardiac functional parameters including right ventricle end-diastolic volume index (RVEDVI), end-systolic volume index (RVESVI), stroke volume index (RVSVI), ejection fraction (RVEF), and SV/ESV; the volumetric parameter; T1 mapping and late gadolinium enhancement (LGE) parameters; strain parameters like RV global longitudinal strain(GLS); and hemodynamics parameters like mean velocity at the pulmonary artery (mvPA) and PA relative area change (PA RAC) were calculated from CMR images. Survival analysis was conducted using Kaplan-Meier and Cox regression. The endpoint was the occurrence of clinical deterioration events. Results: The median follow-up time was 22.27 months (interquartile range: 11.5-31.9 months).RVIP ECV, RVGLS, RVEDVI, RVESVI, RVMI, and RAA, as well as mvPA, SV/ESV, RVEF, and PA RAC, were associated with adverse outcomes. SV/ESV ≤ 0.55, RV GLS > -12.1 %, and PA RAC≤ 16.1 % were significant independent predictors of prognosis. The combined parameters provided incremental prognostic value over COMPERA 2.0 (area under the curve (AUC) from 0.771 to 0.899; P = 0.001).And time-dependent ROC curve confirmed the predictive efficiency of the combined parameters in year 3, with the AUC reaching 0.821(95 % CI: 0.698-0.945). Conclusion: Multiparametric CMR provides a non-invasive, efficient method to assess prognosis in CTD-PAH patients. Key parameters including SV/ESV, RV GLS, and PA RAC significantly predicted survival and confer incremental prognostic utility over COMPERA 2.0, offering reliable prognostic markers for clinical interventions.

Source: European Journal of Radiology Open

DOI: 10.1016/j.ejro.2025.100700