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Updated: Jan 14, 2026
Evaluation of Right Ventricular Function in Experimental Models of Pulmonary Arterial Hypertension
Published on: June 27, 2025
Impact of Lipid Profile Alterations on the Right Heart Function and Prognosis in Pre-Capillary Pulmonary Hypertension
Jiajun Guo1, Ji Zhao1, Jiaqi Wang1
1Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Background And Objective:
The impact of lipid abnormalities on right heart function and outcomes in pre-capillary pulmonary hypertension (precPH) remains unclear. This study investigates how lipid profile alterations influence right heart function, strain, and prognosis in precPH patients.
Methods:
From June 2013 to December 2023, 394 precPH patients were prospectively enrolled. Clinical data, cardiac MRI-derived right heart systolic function, and strain parameters were compared among groups based on lipid profiles. The optimal cut-off values of lipid profiles were determined using the maximally selected rank statistics. Prognostic analyses were conducted using Cox regression and Kaplan-Meier survival methods.
Results:
During a median follow-up of 36 months, 18.8% of patients died. Low-density lipoprotein cholesterol (LDL-C) < 1.93 mmol/L and high-density lipoprotein cholesterol (HDL-C) < 0.82 mmol/L were associated with increased mortality risks (2.51-fold and 2.65-fold, respectively). Multivariate analysis confirmed decreased LDL-C (HR 1.853, 95% CI 1.102-3.115, p = 0.02) and decreased HDL-C (HR 2.019, 95% CI 1.131-3.603, p = 0.02) as independent prognostic indicators. A decrease in either cholesterol subtype predicted worse outcomes (Log-rank p = 0.003). Incorporation of LDL-C and HDL-C enhanced prognostic accuracy of the ESC model (χ2: 50.8 to 60.5, p = 0.007; 50.8 to 66.0, p < 0.001) and ESC-CMR model (χ2: 59.3 to 66.0, p = 0.04; 59.3 to 72.7, p = 0.001). HDL-C < 0.82 mmol/L was associated with impaired right ventricular global longitudinal strain (p < 0.001), RV free wall strain (p < 0.001), and right atrial phasic strain (all p < 0.05).
Conclusions:
Decreased HDL-C and LDL-C levels independently predict increased mortality in precPH patients. Notably, low HDL-C significantly associates with impaired right heart function and strain.
Trial Registration:
Chinese Clinical Trial Registry (https://www.
Clinicaltrials:
gov; ID: ChiCTR1800019314 and ChiCTR1900025518).
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