title: Cardiac magnetic resonance findings predicting mortality in patients with pulmonary arterial hypertension: a systematic review and meta-analysis.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  • 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.
authors: Department of Cardiology, AHMaZON Centre for Adult Congenital Heart Disease, University Medical Centre Utrecht, Radboud University Medical Centre Nijmegen and St. Antonius Hospital Nieuwegein, PO Box 85500, 3508 GA, Utrecht, The Netherlands.|Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors: Vivan J M
authors: VJ
authors: Baggen
authors: Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors: Tim
authors: T
authors: Leiner
authors: Department of Cardiology, AHMaZON Centre for Adult Congenital Heart Disease, University Medical Centre Utrecht, Radboud University Medical Centre Nijmegen and St. Antonius Hospital Nieuwegein, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors: Marco C
authors: MC
authors: Post
authors: Department of Cardiology, AHMaZON Centre for Adult Congenital Heart Disease, University Medical Centre Utrecht, Radboud University Medical Centre Nijmegen and St. Antonius Hospital Nieuwegein, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors: Arie P
authors: AP
authors: van Dijk
authors: Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors: Jolien W
authors: JW
authors: Roos-Hesselink
authors: Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands.|Department of Clinical Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors: Eric
authors: E
authors: Boersma
authors: Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors: Jesse
authors: J
authors: Habets
authors: Department of Cardiology, AHMaZON Centre for Adult Congenital Heart Disease, University Medical Centre Utrecht, Radboud University Medical Centre Nijmegen and St. Antonius Hospital Nieuwegein, PO Box 85500, 3508 GA, Utrecht, The Netherlands. G.T.Sieswerda@umcutrecht.nl.
authors: Gertjan Tj
authors: GT
authors: Sieswerda
mesh_terms: D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D011379:Prognosis; D013318:Stroke Volume; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: Magnetic resonance imaging; Meta-analysis; Mortality; Prognosis; Pulmonary arterial hypertension