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We hypothesized that RV mass\u2010based metrics would discriminate incident PAH as redefined by the lower mean pulmonary arterial pressure (mPAP) threshold of &gt;20\u2009mmHg at the Sixth World Symposium on Pulmonary Hypertension (6th WSPH). Eighty\u2010nine subjects with suspected PAH underwent CMR imaging, including 64 subjects with systemic sclerosis (SSc). CMR metrics, including RV and left ventricular (LV) mass, were measured. All subjects underwent right heart catheterization (RHC) for assessment of hemodynamics within 48 h of CMR. Using generalized linear models, associations between CMR metrics and PAH were assessed, the best subset of CMR variables for predicting PAH were identified, and relationships between mass\u2010based metrics, hemodynamics, and other predictive CMR metrics were examined. Fifty\u2010nine subjects met 6th WSPH criteria for PAH. RV mass metrics, including ventricular mass index (VMI), demonstrated the greatest magnitude difference between subjects with versus without PAH. Overall and in SSc, VMI and RV mass measured by CMR were among the most predictive variables discriminating PAH at RHC, with areas under the receiver operating characteristic curve 0.86 and 0.83. respectively. VMI increased linearly with pulmonary vascular resistance and with mPAP in PAH, including in lower ranges of mPAP associated with mild PAH. VMI\u2009\u2265\u20090.37 yielded a positive predictive value of 90% for discriminating PAH. RV mass metrics measured by CMR, including VMI, discriminate incident, treatment\u2010na\u00efve PAH as defined by 6th WSPH criteria.<\/jats:p>","DOI":"10.1002\/pul2.12005","type":"journal-article","created":{"date-parts":[[2021,12,15]],"date-time":"2021-12-15T15:16:07Z","timestamp":1639581367000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Ventricular mass discriminates pulmonary arterial hypertension as redefined at the Sixth\u00a0World Symposium on Pulmonary Hypertension"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2388-5660","authenticated-orcid":false,"given":"Catherine E.","family":"Simpson","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Pulmonary and Critical Care Medicine Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd 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