Cardiac magnetic resonance (CMR) imaging is an especially effective tool for evaluating patients with pulmonary arterial hypertension (PAH), according to a new meta-analysis published in JACC: Cardiovascular Imaging.
CMR is already known for its strong ability to measure right ventricular (RV) function, the authors noted. With this new meta-analysis, they aimed to take a closer look at the modality’s ability to predict clinical worsening—which they described as “an important composite endpoint used in PAH therapy trials”—and wondered if CMR should be included in more PAH research going forward.
The study’s authors explored data from 22 different studies, covering nearly 2,000 PAH patients. There were 18 clinical worsening events and eight deaths per 100 patient-years.
Overall, the authors found that CMR was “a powerful prognostic marker” that can effectively predict clinical worsening in PAH patients.
Diving deep into the data, the authors wrote that every 1% decrease in RV ejection fraction was linked to a 4.9% increase in the risk of clinical worsening over the next 22 months and a 2.1% increase in the risk of mortality over the next 54 months. Small changes in RV end-system volume index and RV end-diastolic volume index were also associated with an increase in the risk of clinical worsening or mortality.
Changes in left ventricular (LV) stroke volume index or left ventricular end-diastolic volume index, meanwhile, were associated with an increase in the risk of death—but they did not affect the risk of clinical worsening.
“In this meta-analysis, we have shown for the first time in a large cohort of patients that CMR-derived RV volumetric and functional metrics but not LV measurements predict clinical worsening,” wrote lead author Samer Alabed, MD, a specialist at the University of Sheffield in the U.K., and colleagues. “This information should be helpful to regulatory authorities who are keen to ensure that proposed trial endpoints have clinical relevance. In addition, this meta-analysis confirms the prognostic value of CMR metrics in a substantial cohort of patients, which has allowed an assessment of the impact of change on specific metrics concerning clinical worsening, including mortality.”
The full study is available here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.