Marius M Klein, Andreas Voskrebenzev, Filip Klimeš, Milan Speth, Robin A Müller, Karen M Olsson, Julian Glandorf, Claus P Heußel, Ekkehard Grünig, Henning Gall, Ardeschir Ghofrani, Fritz Roller, Sebastian Harth, Helen Marshall, Paul J C Hughes, Andrew J Swift, David G Kiely, Jürgen Behr, Julien Dinkel, Dietrich Beitzke, Irene M Lang, Kai-Helge Schmidt, Karl-Friedrich Kreitner, Thomas Frauenfelder, Silvia Ulrich, Okka W Hamer, Jim Wild, Jens Vogel-Claussen
Purpose To evaluate pulmonary arterial pulse wave velocity (PWV) derived from phase-resolved functional lung (PREFUL) MRI in participants with suspected pulmonary hypertension (PH), assess its association with established markers, and investigate its prognostic value for 12-month mortality. Materials and Methods This post hoc analysis of a prospective multicenter Chronic Thromboembolic Pulmonary Hypertension Diagnosis Europe MRI (CHANGE MRI) study included participants with suspected chronic thromboembolic PH and complete PREFUL MRI between July 2016 and November 2023. PREFUL MRI-based two-dimensional images acquired at 1.5 T using spoiled gradient-echo sequences were used to calculate quantified perfusion, perfusion defect percentages, and PWV. Group comparisons were performed between PH and no PH and among PH groups using age- and sex-adjusted models (analysis of covariance framework). Spearman correlations with right heart catheterization and cardiac MRI parameters and associations with 12-month mortality were assessed using multivariable regression and Cox proportional hazard models. A P value less than .05 was considered statistically significant. Results A total of 632 participants (median age, 66 years; IQR, 22 years; 368 [58%] female) were included. Of these, 415 had confirmed PH, and 13 died within 12 months. PWV was higher in pulmonary arterial hypertension than in chronic thromboembolic PH (2.76 m/sec ± 1.32 vs 1.84 m/sec ± 1.29; P < .001). In participants with PH, PWV was associated with mortality (hazard ratio, 2.28 per SD increase [1.47 m/sec]; P < .001). PWV showed independent associations with right ventricular ejection fraction (β = -0.024 m/sec per percentage point; P < .001) and perfusion defect percentage (β = 0.014 m/sec per percentage point; P = .02). Conclusion Pulmonary arterial PWV derived from PREFUL MRI was higher in PH and independently associated with right ventricular function and 12-month mortality. Keywords: Functional Lung MRI, Pulmonary Arteries, Lung ClinicalTrials.gov identifier: NCT02791282 Supplemental material is available for this article. © RSNA, 2026.