Imaging right ventricular function to predict outcome in pulmonary arterial hypertension

Area of Science:

• Cardiology
• Pulmonary Hypertension Research
• Medical Imaging

Background:

• Right ventricular (RV) function is critical for outcomes in pulmonary arterial hypertension (PAH).
• Current methods for evaluating RV function in PAH lack definitive consensus.
• Optimal assessment of RV adaptation to afterload remains an area of active investigation.

Purpose of the Study:

• To compare the prognostic value of different methods for assessing RV function in PAH.
• To determine the utility of RV-arterial coupling (Ees/Ea) estimates in predicting PAH outcomes.
• To identify the most reliable imaging and invasive parameters for RV function assessment in PAH patients.

Main Methods:

• Cardiac MRI was used to measure RV volumes (ESV, EDV) in 140 PAH patients and 22 controls.
• RV pressures were obtained via right heart catheterization.
• RV-arterial coupling (Ees/Ea) was estimated using both volume (SV/ESV) and pressure (Pmax/mPAP-1) methods; RV function also assessed by EF, RAP, and SV.

Main Results:

• Univariate analysis showed higher Ea, RAP, and lower compliance, SV, and EF predicted outcome.
• RV-arterial coupling (Ees/Ea) by pressure method did not predict outcome, but the volume method (SV/ESV) did.
• Multivariate analysis identified SV/ESV and EF as independent predictors of outcome; declining EF or SV/ESV correlated with poorer survival.

Conclusions:

• Imaging-derived SV/ESV and EF are the optimal methods for evaluating RV function and predicting outcomes in PAH.
• Invasive measurements and simplified pressure-derived estimates of RV-arterial coupling provide no additional prognostic information.
• These findings refine the approach to RV function assessment in PAH management.