Prognostic Value of Cardiac MRI–derived Left Ventricular Layer–specific Strain in Pulmonary Arterial Hypertension

Purpose To investigate the prognostic value of cardiac MRI-derived left ventricular (LV) layer-specific strain in pulmonary arterial hypertension (PAH). Materials and Methods This study analyzed data from a subcohort of participants consecutively enrolled in the prospective PAH registry study between January 2011 and December 2017 who underwent right heart catheterization and cardiac MRI (1.5-T scanner) within 1 week. The deformable registration algorithm software was used to analyze LV layer-specific strain from acquired breath-held cine images. Each participant was followed up at intervals of 6 months plus or minus 2 weeks for all-cause mortality. Cox regression and Kaplan-Meier analyses were performed to assess the association between LV layer-specific strain and all-cause mortality. Results Eighty participants with PAH (mean age ± SD, 30.30 years ± 9.73; 62 female, 18 male) were included, with a median follow-up of 1511 days. At the end, 29 (36%) participants died by any cause. Participants who survived had significantly higher endocardial wall peak systolic radial strain rate (ewSRSR; 72.74% ± 50.64 vs 30.61% ± 67.43; P = .005) and transmural gradient from the epicardial to endocardial walls in peak late diastolic circumferential strain rate (Gepiw-ewDCSR_L; -20.05% ± 22.97 vs -33.50% ± 25.71; P = .02) compared with participants who died. Multivariable Cox regression showed that ewSRSR and Gepiw-ewDCSR_L were independent predictors of all-cause mortality. Kaplan-Meier analysis showed that participants with PAH with ewSRSR less than 54.48% (log-rank P = .003) or Gepiw-ewDCSR_L less than -25.14% (log-rank P = .02) at baseline had a decreased likelihood of long-term survival. In the low- or intermediate-risk PAH groups, participants with LV ewSRSR less than 54.48% had a worse prognosis (log-rank P = .02). Conclusion Cardiac MRI-derived LV ewSRSR and Gepiw-ewDCSR_L independently predicted all-cause mortality in participants with PAH. Keywords: Layer-specific Strain, DRA-CMR, Left Ventricle, Pulmonary Arterial Hypertension, Prognosis ClinicalTrials.gov: NCT01417338 Supplemental material is available for this article. © RSNA, 2025.