Pulmonary vascular disease & thromboembolismCohort study
Optimal Strain Combinations for Prognostic Prediction in Pulmonary Arterial Hypertension
- Prospective study (patients prospectively recruited)
- elastic net Cox regression and stepwise Cox regression with the Akaike information criterion
- landmark analysis
Authors' conclusion
The combined assessment of left ventricular global longitudinal strain and right atrial reservoir strain yields the strongest prognostic utility among the strain parameters in pulmonary arterial hypertension, significantly improves risk stratification beyond several established cardiac magnetic resonance and clinical predictors, and holds promise as a practical tool for guiding management strategies.
Study context
- Population
- Patients diagnosed with pulmonary arterial hypertension between June 2013 and June 2024patients with pulmonary arterial hypertension (mean age, 42±15 years)
- Participants
- 269 patients
- Exposure
- Combination of left ventricular global longitudinal strain and right atrial reservoir strain vs conventional cardiac magnetic resonance and clinical models
- Outcome
- Primary end point
- Follow-up
- Median 39.3 months
Main finding
As reported in the abstract
Patients reaching the primary end point
68
Observational data: associations, not effects.
Secondary outcomes
| Outcome | hazard ratio (per 5% increase) (95% CI) | P value | |
|---|---|---|---|
| All-cause mortality (independent predictors) — left ventricular global longitudinal strain, per 5% increase | 1.46 (1.07–2.00) | P = 0.02 | |
| All-cause mortality (independent predictors) — right atrial reservoir strain, per 5% increase | 0.77 (0.62–0.95) | P = 0.02 | |
| 0.512Hazard ratio (log scale) |
Mortality by risk group · 1-year
- Mortality by risk group: P <0.001
Secondary end point · median follow-up of 39.3 months
- Patients reaching the secondary end point
- 91
Strongest prognostic combination of strain parameters
- The combination of left ventricular global longitudinal strain and right atrial reservoir strain had the strongest prognostic value
Discrimination vs conventional cardiac magnetic resonance and clinical models
- Higher C-index values for the combination
- all P ≤0.05
Landmark analysis
- Landmark analysis confirmed their long-term prognostic relevance
Original publication
Summarised from the published abstract; every number is checked against it