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.

Additional Metadata
Keywords Magnetic resonance imaging, Meta-analysis, Mortality, Prognosis, Pulmonary arterial hypertension
Persistent URL dx.doi.org/10.1007/s00330-016-4217-6, hdl.handle.net/1765/81336
Journal European Radiology: journal of the European Congress of Radiology
Citation
Baggen, V.J.M, Leiner, I, Post, M.C, van Dijk, A.P.J, Roos-Hesselink, J.W, Boersma, H, … Sieswerda, G.T. (2016). Cardiac magnetic resonance findings predicting mortality in patients with pulmonary arterial hypertension: a systematic review and meta-analysis. European Radiology: journal of the European Congress of Radiology (Vol. 26, pp. 3771–3780). doi:10.1007/s00330-016-4217-6