Cardiac magnetic resonance parameters for prognostic stratification in pulmonary hypertension: A longitudinal study

Cardiac magnetic resonance (CMR) imaging is a critical tool for the diagnosis and evaluation of pulmonary hypertension (PH). This study aimed to investigate the temporal changes in cardiac morphological and functional characteristics in PH using CMR, with the goal of identifying early indicators of adverse clinical outcomes. This retrospective study included patients diagnosed with PH using right heart catheterization. Each patient underwent two CMR sessions, approximately 1.5 years apart, for follow-up. CMR characteristics, including morphological and functional parameters such as myocardial strain, were analyzed in relation to the primary adverse events endpoint, defined as a composite of heart failure hospitalization and all-cause mortality. A total of 36 patients (8 men and 28 women, mean age 48.0±13.3 years) were enrolled. Eleven patients (30.6%) experienced adverse events after the second CMR. High right ventricular (RV) volume and worse RV strain at follow-up were observed in patients who experienced future events (RV end-diastolic volume RVEDV, 247.2 mL vs. 182.3 mL, p = 0.029; and right ventricular global longitudinal strain RVGLS, -12.0% vs. -17.1%, p = 0.021, respectively). In contrast, an increase in left ventricular ejection fraction (LVEF) and left ventricular (LV) volume was noted in patients without events, whereas a decrease in LV end-diastolic volume was associated with subsequent events (111.6 mL vs. 123.9 mL, p = 0.024). An increase in LVEF was observed in patients without events (61.5% vs. 57.3%, p = 0.030), underscoring the predictive value of LV function. This study emphasizes the value of CMR in monitoring patients with PH, particularly for assessing ventricular function as a predictor of future outcomes. The observed trends in myocardial strain highlight its potential as a prognostic marker, warranting further research to confirm its clinical utility.