Author + information
- Samer Alabed, MDa,b,1 (, )
- Yousef Shahin, MDa,b,
- Pankaj Garg, PhDa,
- Faisal Alandejani, MDa,
- Christopher S. Johns, PhDa,b,
- Robert A. Lewis, MDa,c,
- Robin Condliffe, MDc,
- James M. Wild, PhDa,d,
- David G. Kiely, MDa,c,d,∗ and
- Andrew J. Swift, PhDa,b,d,∗
- aDepartment of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- bDepartment of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
- cSheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
- dINSIGNEO, Institute for in silico medicine, University of Sheffield, UK
- ↵1Corresponding author: Dr Samer Alabed Cardiac MRI Research Fellow and Specialist Registrar in Cardiac Radiology Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Glossop Road, Sheffield, S10 2JF, United Kingdom Tel: 0114 243 4343
Objectives This meta-analysis evaluates cardiac magnetic resonance imaging (CMR) assessment of pulmonary arterial hypertension (PAH), with a focus on clinical worsening and mortality.
Background CMR has prognostic value in the assessment of patients with PAH. However, there is limited data on the prediction of clinical worsening, an important composite end-point used in PAH therapy trials.
Methods Central, Medline, Embase and Web of Science were searched in May 2020. All CMR studies assessing clinical worsening and the prognosis of patients with PAH were included. Pooled hazard ratios of univariate regression analyses for CMR measurements, for prediction of clinical worsening and mortality, were calculated.
Results We included 22 studies with 1,938 participants in the meta-analysis. There were 18 clinical worsening events and 8 deaths per 100 patient-years. The pooled hazard ratios show that every 1% decrease in RVEF is associated with a 4.9% increase in the risk of clinical worsening over 22 months of follow-up and a 2.2% increase in the risk of death over 54 months. For every 1 ml/m2 increase in RVESVI or RVEDVI, the risk of clinical worsening increases by 1.3% and 0.7%, respectively and the risk of mortality increases by 0.9% and 1%, respectively. Every 1 ml/m2 decrease in LVESVI or LVEDVI increased the risk of death by 2.1% and 2.3% respectively. LV parameters were not associated with clinical worsening.
Conclusion This review confirms CMR as a powerful prognostic marker in PAH in a large cohort of patients. In addition to confirming previous observations that RV function and RV and LV volumes predict mortality, RV function and volumes also predict clinical worsening. This study provides a strong rationale for considering CMR as a clinically relevant end-point for trials of PAH therapies.
↵∗ contributed equally to the manuscript
Funding: The study was supported by the Wellcome Trust grants 215799/Z/19/Z
and 205188/Z/16/Z. The funder did not have any role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, and in the preparation, review, or approval of the manuscript.
Conflicts of interests: None.
- Received July 20, 2020.
- Revision received August 17, 2020.
- Accepted August 21, 2020.
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