Study: MRI May Be Useful for Predicting PAH Outcomes
A recent study found that magnetic resonance imaging (MRI) could be useful for predicting outcomes in patients with pulmonary arterial hypertension (PAH).
The study included 576 patients with PAH undergoing MRI from the ASPIRE-Pulmonary-Hypertension-Registry. Patients were followed for a median of 42 months, and were evenly divided into a derivation or validation cohort to assess the sensitivity and specificity of MRI predictors.
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________________________________________________________________________________________________________________________________________________________________Overall, 221 patients died over the course of the study; 115 of patients who died were in the derivation cohort and 106 were in the validation cohort.
Right-ventricular end-systolic volume and relative area change of the pulmonary artery were found to be independent predictors of mortality and outcomes of PAH.
Data from the derivation cohort and the MRI model predicted mortality in the validation cohort at 1 year with a sensitivity of 70 (95% CI 53-83), specificity of 62 (95% CI 62-68), positive predictive value (PPV) of 24 (95% CI 16-32) and negative predictive value (NPV) of 92 (95% CI 87-96).
At 3 years, the model predicted mortality with a sensitivity of 77 (95% CI 67-85), specificity of 73 (95% CI 66-85), PPV of 56 (95% CI 47-65) and NPV of 87 (95% CI 81-92).
The accuracy of the model was higher for patients with idiopathic pulmonary arterial hypertension at 3 years, with a sensitivity of 89 (95% CI 65-84), specificity of 76 (95% CI 65-84), PPV of 60 (95% CI 46-74) and NPV of 94 (95% CI 85-98).
“MRI measurements reflecting [right ventricular] structure and stiffness of the proximal pulmonary vasculature are independent predictors of outcome in PAH,” the researchers concluded. “In combination with clinical data, MRI has moderate prognostic accuracy in the evaluation of patients with PAH,” the researchers concluded.
—Melissa Weiss
Reference:
Swift AJ, Capener D, Johns C, et al. Magnetic resonance imaging in the prognostic evaluation of patients with pulmonary arterial hypertension [published online March 22, 2017]. Am J Respir Crit Care Med. https://doi.org/10.1164/rccm.201611-2365OC.