Biventricular Function and Strain by Cardiac MRI Predict Five-Year Mortality in Precapillary Pulmonary Hypertension

Introduction Pulmonary hypertension (PH) is a rare, progressive disease that leads to right ventricular dysfunction and high mortality. Recent studies highlight the prognostic value of cardiac magnetic resonance imaging (CMRI)- derived functional and deformation parameters, which may improve risk stratification and long-term survival in patients with PH. Objectives: 1. To evaluate the five-year survival of patients with precapillary PH, treated at the Pulmonary Hypertension Centre, Hospital of LSMU Kauno Klinikos. 2. To identify the prognostic value of baseline right and left ventricular (RV and LV) geometry, function, and deformation indices, determined by CMRI, for five-year survival in patients with precapillary PH. Materials and methods: A retrospective study was conducted by analysing 55 patients with precapillary PH treated at The Pulmonary Hypertension Centre, Hospital of LSMU Kauno Klinikos. Clinical features at the time of diagnosis, levels of serum NT-proBNP concentration, 6-minute walking test results, and both ventricles’ functional and deformation parameters determined by CMRI were assessed. Data were analysed using the IBM SPSS Statistics 29.0 software, and differences were considered statistically significant at p < 0.05. Results: The five-year survival rate was 46.75%. Non-survivors had increased levels of serum NT-proBNP (1089.0 [239.0–2541.5] vs 2064.5 [1375.3–5473.5] ng/ml, p = 0.014), decreased LV global longitudinal strain (GLS) (-18.4 [-24.9–(-15.3)] vs -15.3 [-19.4–(-10.2)] %, p = 0.042), reduced RV ejection fraction (EF) (45.0 [34.5–54.0] vs 34.0 [24.3–40.8] %, p = 0.005), increased RV end-systolic volume index (ESVi) (44.0 [25.5– 66.5] vs. 62.0 [48.0–88.0], ml/m2 , p = 0.007), and lower RV free wall longitudinal strain (FWLS) (-20.5 [-27.4– (-15.8)] vs -13.9 [-18.1–(-11.0)] %, p = 0.004), when compared to survivors at the time of diagnosis. Threshold values associated with increased five-year mortality risk included NT-proBNP level of ≥ 534.5 ng/l, LV GLS ≥ -12.75%, RV EF ≤ 43.5%, RV FWLS ≥ -17.7%, and RV ESVi of ≥ 45.5 ml/m2 . Conclusions: Reduced longitudinal strain in both ventricles and lower right ventricular ejection fraction, as determined by CMRI, are associated with a higher risk of mortality within five years following the precapillary PH diagnosis.