Diverse Right Ventricular Remodeling Evaluated by MRI and Prognosis in Eisenmenger Syndrome With Different Shunt Locations

Background Congenital shunt location is related to Eisenmenger syndrome (ES) survival. Moreover, right ventricular (RV) remodeling is associated with poor survival in pulmonary hypertension. Purpose To investigate RV remodeling using comprehensive magnetic resonance imaging (MRI) techniques and identify its relationship with prognosis in ES subgroups classified by shunt location. Study Type Prospective observational study. Population Fifty‐four adults with ES (16 with pre‐tricuspid shunt and 38 with post‐tricuspid shunt). Field Strength/Sequence 3.0 T/cine MRI with balanced steady‐state free precession sequence, late gadolinium enhancement with inversion recovery segmented gradient echo sequence and phase‐sensitive reconstruction, and T1 mapping with modified Look‐Locker inversion recovery sequence. Assessment Demographics, clinical characteristics, hemodynamics, RV remodeling features (morphology, systolic function, RV–pulmonary artery (PA) coupling and myocardial fibrosis), and prognosis were compared between ES subgroups. The adverse endpoint was all‐cause mortality or readmission for heart failure. Statistical Tests The independent samples t‐test, Fisher's exact test or Chi‐squared test, and the Kaplan–Meier method were used. P