{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T03:11:07Z","timestamp":1791861067938,"version":"4.3.4"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T00:00:00Z","timestamp":1701302400000},"content-version":"vor","delay-in-days":60,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pulm. circ."],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Pulmonary arterial hypertension (PAH) still remains a life\u2010threatening disorder with poor prognosis. The right ventricle (RV) adapts to the increased afterload by a series of prognostically significant morphological and functional changes, the adaptive nature should also be understood in the context of ventricular interdependence. We hypothesized that left ventricle (LV) underfilling could serve as an important imaging marker for identifying maladaptive changes and predicting clinical outcomes in PAH patients. We prospectively enrolled patients with PAH who underwent both cardiac magnetic resonance and right heart catheterization between October 2013 and December 2020. Patients were categorized into four groups based on their LV and RV mass\/volume ratio (M\/V). LV M\/V was stratified using the normal value (0.7\u2009g\/mL for males and 0.6\u2009g\/mL for females) to identify patients with LV underfilling (M\/V\u2009\u2265\u2009normal value), while RV M\/V was stratified based on the median value. The primary endpoint was all\u2010cause mortality, and the composite endpoints included all\u2010cause mortality and heart failure\u2010related readmissions. A total of 190 PAH patients (53 male, mean age 37 years) were included in this study. Patients with LV underfilling exhibited higher NT\u2010proBNP levels, increased RV mass, larger RV but smaller LV, lower right ventricular ejection fraction, and shorter 6\u2010min walking distance. Patients with LV underfilling had a 2.7\u2010fold higher risk of mortality than those without and LV M\/V (hazard ratio [per 0.1\u2009g\/mL increase]: 1.271, 95% confidence interval: 1.082\u20131.494, <jats:italic>p<\/jats:italic>\u2009=\u20090.004) was also independent predictors of all\u2010cause mortality. Moreover, patients with low LV M\/V had a better prognosis regardless of the level of RV M\/V. Thus, LV underfilling is an independent predictor of adverse clinical outcomes in patients with PAH, and it could be an important imaging marker for identifying maladaptive changes in these patients.<\/jats:p>","DOI":"10.1002\/pul2.12309","type":"journal-article","created":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T05:29:36Z","timestamp":1701408576000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Left ventricular underfilling in PAH: A potential indicator for adaptive\u2010to\u2010maladaptive transition"],"prefix":"10.1002","volume":"13","author":[{"given":"Jiajun","family":"Guo","sequence":"first","affiliation":[{"name":"Department of Cardiology, West China Hospital Sichuan University Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, West China Hospital Sichuan 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