title: Prognostic significance of cardiac magnetic resonance imaging in children with pulmonary hypertension.
abstract: BACKGROUND
  There are very few validated prognostic markers in pediatric pulmonary hypertension. Cardiac MRI is a useful, noninvasive method for determining prognosis in adults. The present study is the first to assess its prognostic value in children.
  
  
  RESULTS
  A total of 100 children with pulmonary hypertension (median, 10.4 years; range, 0.5-17.6 years) were evaluated (idiopathic, n=60; repaired congenital heart disease, n=22; miscellaneous, n=18). In all patients, ventricular volumes and great vessel flow were measured. Volumetric data were obtained using retrospectively gated cine imaging (n=37) or real-time imaging (n=63), depending on the patient's ability to hold his or her breath. During a median follow-up of 1.9 years, 11 patients died and 3 received lung transplantation. Of the cardiac MR parameters measured, right ventricular ejection fraction and left ventricular stroke volume index were most strongly predictive of survival on univariate analysis (2.6- and 2.5-fold increase in mortality for every 1-SD decrease, respectively; P<0.05). These results were reflected in good separation of tertile-based Kaplan-Meier survival curves for these variables.
  
  
  CONCLUSIONS
  Cardiac MR measures correlate with clinical status and prognosis in children with pulmonary hypertension. Cardiac MR is feasible and may be useful in clinical decision making in pediatric pulmonary hypertension.
authors.affiliation: Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Unuiversity College London, UK.
authors.forename: Shahin
authors.initials: S
authors.lastname: Moledina
authors.forename: Bejal
authors.initials: B
authors.lastname: Pandya
authors.forename: Margarita
authors.initials: M
authors.lastname: Bartsota
authors.forename: Kristian H
authors.initials: KH
authors.lastname: Mortensen
authors.forename: Merlin
authors.initials: M
authors.lastname: McMillan
authors.forename: Sadia
authors.initials: S
authors.lastname: Quyam
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Taylor
authors.forename: Sheila G
authors.initials: SG
authors.lastname: Haworth
authors.forename: Ingram
authors.initials: I
authors.lastname: Schulze-Neick
authors.forename: Vivek
authors.initials: V
authors.lastname: Muthurangu
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000704:Analysis of Variance; D062485:Breath Holding; D055424:Cardiac-Gated Imaging Techniques; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D007223:Infant; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016040:Lung Transplantation; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D006113:United Kingdom; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
keywords: MRI; echocardiography; hypertension; pediatric; prognosis; pulmonary