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Cardiac Magnetic Resonance Findings and Their Association with Clinical Outcomes in Pediatric Pulmonary Arterial

Meryem Beyazal1, Merter Keceli2, Oguzhan Dogan1

  • 1Pediatric Cardiology Department, Children Hospital, Ankara Bilkent City Hospital, Ankara 06800, Turkey.

Journal of Clinical Medicine
|February 13, 2026
PubMed

Insights

Cardiac magnetic resonance (CMR) reveals key indicators of mortality in pediatric pulmonary arterial hypertension (PAH). Ventricular mass index (VMI) and septal morphology significantly impact survival, aiding in risk stratification for children with PAH.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Imaging
  • Pulmonary Hypertension Research

Background:

  • Cardiac magnetic resonance (CMR) is a vital non-invasive tool for assessing ventricular function in pediatric pulmonary arterial hypertension (PAH).
  • However, CMR parameters specific to pediatric PAH remain largely underexplored.
  • This study aims to elucidate the role of CMR in evaluating pediatric PAH patients.

Purpose of the Study:

  • To prospectively evaluate cardiac magnetic resonance (CMR) parameters in children with pulmonary arterial hypertension (PAH).
  • To identify CMR-derived metrics associated with mortality and clinical variables.
  • To explore the potential of CMR in risk stratification for pediatric PAH.

Main Methods:

  • Thirty-six children with PAH underwent CMR to assess ventricular volumetric and functional parameters.
  • Key parameters included right and left ventricular ejection fraction (RVEF, LVEF), end-systolic volumes (RVESVi, LVESVi), and ventricular mass index (VMI).
  • Clinical data (BNP, NYHA class, 6MWD) and survival analyses (logistic regression, Kaplan-Meier) were correlated with CMR findings.

Main Results:

  • Right ventricular ejection fraction (RVEF) negatively correlated with brain natriuretic peptide (BNP) (r = -0.538, p = 0.001).
  • Decreased RVEF, LVESVi, and VMI were associated with mortality in univariate analysis.
  • Higher VMI (> 0.75) and leftward septal shift significantly correlated with lower one-year survival (p = 0.016 and p = 0.040, respectively).

Conclusions:

  • Right ventricular ejection fraction (RVEF), left ventricular end-systolic volume index (LVESVi), and ventricular mass index (VMI) are significant predictors of mortality in pediatric PAH.
  • BNP levels reflect right ventricular dysfunction in this population.
  • VMI and septal morphology identified via CMR are valuable markers for enhancing risk stratification in children with PAH.

Keywords:
cardiac magnetic resonancepediatric pulmonary arterial hypertensionprognosisright ventricular function

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