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European Radiology
Published in: European Radiology 11/2016

Open Access 01-11-2016 | Cardiac

Cardiac magnetic resonance findings predicting mortality in patients with pulmonary arterial hypertension: a systematic review and meta-analysis

Authors: Vivan J. M. Baggen, Tim Leiner, Marco C. Post, Arie P. van Dijk, Jolien W. Roos-Hesselink, Eric Boersma, Jesse Habets, Gertjan Tj. Sieswerda

Published in: European Radiology | Issue 11/2016

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Abstract

Objectives

To provide a comprehensive overview of all reported cardiac magnetic resonance (CMR) findings that predict clinical deterioration in pulmonary arterial hypertension (PAH).

Methods

MEDLINE and EMBASE electronic databases were systematically searched for longitudinal studies published by April 2015 that reported associations between CMR findings and adverse clinical outcome in PAH. Studies were appraised using previously developed criteria for prognostic studies. Meta-analysis using random effect models was performed for CMR findings investigated by three or more studies.

Results

Eight papers (539 patients) investigating 21 different CMR findings were included. Meta-analysis showed that right ventricular (RV) ejection fraction was the strongest predictor of mortality in PAH (pooled HR 1.23 [95 % CI 1.07–1.41], p = 0.003) per 5 % decrease. In addition, RV end-diastolic volume index (pooled HR 1.06 [95 % CI 1.00–1.12], p = 0.049), RV end-systolic volume index (pooled HR 1.05 [95 % CI 1.01–1.09], p = 0.013) and left ventricular end-diastolic volume index (pooled HR 1.16 [95 % CI 1.00–1.34], p = 0.045) were of prognostic importance. RV and LV mass did not provide prognostic information (p = 0.852 and p = 0.983, respectively).

Conclusion

This meta-analysis substantiates the clinical yield of specific CMR findings in the prognostication of PAH patients. Decreased RV ejection is the strongest and most well established predictor of mortality.

Key Points

• Cardiac magnetic resonance imaging is useful for prognostication in pulmonary arterial hypertension.
• Right ventricular ejection fraction is the strongest predictor of mortality.
• Serial CMR evaluation seems to be of additional prognostic importance.
• Accurate prognostication can aid in adequate and timely intensification of PAH-specific therapy.
Appendix
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Metadata
Title
Cardiac magnetic resonance findings predicting mortality in patients with pulmonary arterial hypertension: a systematic review and meta-analysis
Authors
Vivan J. M. Baggen
Tim Leiner
Marco C. Post
Arie P. van Dijk
Jolien W. Roos-Hesselink
Eric Boersma
Jesse Habets
Gertjan Tj. Sieswerda
Publication date
01-11-2016
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-016-4217-6

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