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Meta-Analysis
. 2016 Nov;26(11):3771-3780.
doi: 10.1007/s00330-016-4217-6. Epub 2016 Feb 4.

Cardiac magnetic resonance findings predicting mortality in patients with pulmonary arterial hypertension: a systematic review and meta-analysis

Vivan J M Baggen  1   2 , Tim Leiner  3 , Marco C Post  1 , Arie P van Dijk  1 , Jolien W Roos-Hesselink  2 , Eric Boersma  2   4 , Jesse Habets  3 , Gertjan Tj Sieswerda  5
Affiliations
Meta-Analysis

Cardiac magnetic resonance findings predicting mortality in patients with pulmonary arterial hypertension: a systematic review and meta-analysis

Vivan J M Baggen et al. Eur Radiol. 2016 Nov.

Abstract

Objectives: To provide a comprehensive overview of all reported cardiac magnetic resonance (CMR) findings that predict clinical deterioration in pulmonary arterial hypertension (PAH).

Methods: MEDLINE and EMBASE electronic databases were systematically searched for longitudinal studies published by April 2015 that reported associations between CMR findings and adverse clinical outcome in PAH. Studies were appraised using previously developed criteria for prognostic studies. Meta-analysis using random effect models was performed for CMR findings investigated by three or more studies.

Results: Eight papers (539 patients) investigating 21 different CMR findings were included. Meta-analysis showed that right ventricular (RV) ejection fraction was the strongest predictor of mortality in PAH (pooled HR 1.23 [95 % CI 1.07-1.41], p = 0.003) per 5 % decrease. In addition, RV end-diastolic volume index (pooled HR 1.06 [95 % CI 1.00-1.12], p = 0.049), RV end-systolic volume index (pooled HR 1.05 [95 % CI 1.01-1.09], p = 0.013) and left ventricular end-diastolic volume index (pooled HR 1.16 [95 % CI 1.00-1.34], p = 0.045) were of prognostic importance. RV and LV mass did not provide prognostic information (p = 0.852 and p = 0.983, respectively).

Conclusion: This meta-analysis substantiates the clinical yield of specific CMR findings in the prognostication of PAH patients. Decreased RV ejection is the strongest and most well established predictor of mortality.

Key points: • Cardiac magnetic resonance imaging is useful for prognostication in pulmonary arterial hypertension. • Right ventricular ejection fraction is the strongest predictor of mortality. • Serial CMR evaluation seems to be of additional prognostic importance. • Accurate prognostication can aid in adequate and timely intensification of PAH-specific therapy.

Keywords: Magnetic resonance imaging; Meta-analysis; Mortality; Prognosis; Pulmonary arterial hypertension.

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Figures

Fig. 1
Fig. 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2009 flow diagram. * One study investigated both echocardiographic and cardiac magnetic resonance imaging (CMR) findings. PAH pulmonary arterial hypertension
Fig. 2
Fig. 2
Prognostic value of cardiac magnetic resonance imaging (CMR) findings evaluated by three or more studies. Values are presented as mean [95 % confidence interval]. EDVI end-diastolic volume index, EF ejection fraction, ESVI end-systolic volume index, LV left ventricular, MI mass index, RV right ventricular, SVI stroke volume index
See this image and copyright information in PMC

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