title: Prognostic Value of Pulmonary Vascular Resistance by Magnetic Resonance in Systolic Heart Failure.
abstract: BACKGROUND
  Pulmonary hypertension is associated with poor prognosis in heart failure. However, non-invasive diagnosis is still challenging in clinical practice.
  
  
  OBJECTIVE
  We sought to assess the prognostic utility of non-invasive estimation of pulmonary vascular resistances (PVR) by cardiovascular magnetic resonance to predict adverse cardiovascular outcomes in heart failure with reduced ejection fraction (HFrEF).
  
  
  METHODS
  Prospective registry of patients with left ventricular ejection fraction (LVEF) < 40% and recently admitted for decompensated heart failure during three years. PVR were calculated based on right ventricular ejection fraction and average velocity of the pulmonary artery estimated during cardiac magnetic resonance. Readmission for heart failure and all-cause mortality were considered as adverse events at follow-up.
  
  
  RESULTS
  105 patients (average LVEF 26.0 ± 7.7%, ischemic etiology 43%) were included. Patients with adverse events at long-term follow-up had higher values of PVR (6.93 ± 1.9 vs. 4.6 ± 1.7 estimated Wood Units (eWu), p < 0.001). In multivariate Cox regression analysis, PVR ≥ 5 eWu(cutoff value according to ROC curve) was independently associated with increased risk of adverse events at 9 months follow-up (HR2.98; 95% CI 1.12-7.88; p < 0.03).
  
  
  CONCLUSIONS
  In patients with HFrEF, the presence of PVR ≥ 5.0 Wu is associated with significantly worse clinical outcome at follow-up. Non-invasive estimation of PVR by cardiac magnetic resonance might be useful for risk stratification in HFrEF, irrespective of etiology, presence of late gadolinium enhancement or LVEF.
authors: Departamento de Cardiologia, Hospital General Universitario de Valencia, Valencia, Spain.
authors: Óscar
authors: Ó
authors: Fabregat-Andrés
authors: Unidad de Imagen Cardiaca - ERESA, Hospital General Universitario de Valencia, Valencia, Spain.
authors: Jordi
authors: J
authors: Estornell-Erill
authors: Departamento de Cardiologia, Hospital General Universitario de Valencia, Valencia, Spain.
authors: Francisco
authors: F
authors: Ridocci-Soriano
authors: Departamento de Cardiologia, Hospital General Universitario de Valencia, Valencia, Spain.
authors: José Leandro
authors: JL
authors: Pérez-Boscá
authors: Unidad de Imagen Cardiaca - ERESA, Hospital General Universitario de Valencia, Valencia, Spain.
authors: Pilar
authors: P
authors: García-González
authors: Departamento de Cardiologia, Hospital General Universitario de Valencia, Valencia, Spain.
authors: Rafael
authors: R
authors: Payá-Serrano
authors: Departamento de Cardiologia, Hospital General Universitario de Valencia, Valencia, Spain.
authors: Salvador
authors: S
authors: Morell
authors: Fundación para la Investigación, Hospital General Universitario de Valencia, Valencia, Spain.
authors: Julio
authors: J
authors: Cortijo
mesh_terms: D000368:Aged; D005260:Female; D054143:Heart Failure, Systolic / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000592:standards*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D014655:Vascular Resistance / Q000502:physiology*