Objective Pulmonary arterial hypertension (PAH) is a progressive malignant disease and has poor prognosis, ultimately leading to right heart failure and even death if untreated. Early diagnosis is in favor of early intervention to prevent right heart failure. Cardiac magnetic resonance (CMR) imaging has been regarded as an ideal tool to diagnose, assess and monitor patients with PAH non-invasivily. The aim of this study was to further investigate the relationship between CMR parameters and PAH patient severity and prognosis, revealing the important value of CMR in assessing PAH. Methods CMR was performed in 47 PAH patients whose diagnosis had been confirmed with right heart catheterization(RHC) in Tianjin Medical University General Hospital. CMR images were post-processed and the left and right ventricular function parameters were calculated. Patients were followed up until to the occurrence of adverse events. The relationship between baseline CMR and RHC parameters was evaluated with Pearson coefficient, and the follow-up outcome was studied with ROC curves and Cox regression survival analysis. Results At baseline, the CMR measurement have a strong correlation with the mPAP. At follow-up, compared to No Adverse Event Group, the RVEF, TAPSE, and LVSVI were significantly decreased in the Adverse Event Group, while the VMI was significantly increased in the Adverse Event Group (P<0.05). The ROC analysis identified the VMI had the highest AUC value (AUC=0.819) predicting adverse event, with a sensitivity of 69.2%and a specificity of 85.3%.Additionally, the RVEF and TAPSE predicted the adverse event with indentical sensitivity (84.5%). Based on cut-off value of 29.08 mL/m2, the specificity in predicting PAH mortality for LVSVI was 91.2%. According to Kaplan-Meier survival curves, survival was lower in patients with an inframedian RVEF<30.15%, TAPSE<15.8 mm, and LVSVI<29.08 mL/m 2, and a supramedian VMI<0.76. Conclusion RVEF, TAPSE, LVSVI, and VMI assessed with CMR predict outcomes in patients with PAH. A reduced RVEF, TAPSE, LVSVI, and a large VMI are strong predictors of mortality and severity.%目的：肺动脉高压（PAH）是一种恶性进展性疾病，预后较差，最终可引起右心功能衰竭而致死亡。早期明确PAH诊断有利于进行早期合理干预以防止右心功能衰竭。心脏MR（CMR）成像已成为无创诊断、评估及监测PAH的理想方法。本研究旨在进一步探讨CMR成像指标与PAH病人病情严重程度和预后之间的关系，揭示CMR成像在评估PAH的重要价值。方法收集天津医科大学总医院经右心导管（RHC）确诊的PAH病人47例，男2例，女45例，平均（41．09±11．76）岁，对其行心脏电影MRI（cine-MRI）扫描及影像分析，测量并计算出常规左、右心功能相关指标。对病人进行随访，随访终点为发生不良事件，对基线资料（RHC和CMR相关指标）进行Pearson相关性分析，根据随访结果采用Kaplan-Meier法绘制ROC曲线并做生存分析。结果在基线水平，CMR成像心功能指标与平均肺动脉压具有良好的相关性。与未发生不良事件组相比，发生不良事件组的右心室射血分数（RVEF）、三尖瓣环收缩期位移（TAPSE）、左心室每搏输出量指数（LVSVI）均较低，心室质量指数（VMI）较高（P＜0．05）。使用ROC曲线分析病人是否发生不良事件的结果显示，VMI的曲线下面积（AUC）最大为0．819，其敏感度及特异度分别为69．2%、85．3%；RVEF、TAPSE敏感度较高（84．5%），LVSVI特异度较高（91．2%）。据ROC曲线获得的临界值分组并进行Kaplan-Meier生存曲线结果显示：RVEF＜30．15%、TAPSE＜15．8 mm、LVSVI＜29．08 mL/m2及VMI＞0．76组不良事件的发生率明显增加。结论 RVEF、TAPSE、LVSVI降低及VMI升高提示PAH病情较重，发生不良事件的可能性较大。使用CMR计算的心功能指标可用于PAH病人的严重程度及预后的评估和预测。
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