Sotatercept improves right ventricular function but is associated with new or worsening pericardial effusions: a CMR study in intermediate-high risk PAH.
Virsinskaite, Ruta Beattie, Catherine J Karia, Nina Kotecha, Tushar Schreiber, Benjamin E Suntharalingam, Jay MacKenzie Ross, Robert V Hughes, Philip D Lentaigne, Julian Scott-Russell, Ann M
Virsinskaite, Ruta
Beattie, Catherine J
Karia, Nina
Kotecha, Tushar
Schreiber, Benjamin E
Suntharalingam, Jay
MacKenzie Ross, Robert V
Hughes, Philip D
Lentaigne, Julian
Scott-Russell, Ann M
Abstract
BACKGROUND: Sotatercept is a novel drug therapy for pulmonary arterial hypertension (PAH) that significantly reduces clinical worsening and improves exercise capacity, functional class and pulmonary haemodynamics. This study aims to use cardiovascular magnetic resonance (CMR) to monitor the cardiac response to sotatercept in patients with PAH.
METHODS: Patients with PAH at intermediate-high or high mortality risk and already on background maximal triple PAH therapies, including parenteral prostacyclin analogue for at least 3 months, were offered enrolment to a patient access program for sotatercept at the Royal Free Hospital National Pulmonary Hypertension Service. Baseline and follow-up CMR studies were performed at a median interval of 24 (interquartile range 6) weeks.
RESULTS: 18 out of 23 patients enrolled to the sotatercept access program underwent baseline and follow-up CMR studies (3 patients paused or discontinued sotatercept prior to 12 weeks; 2 patients were unable to undergo CMR). All 18 patients were stratified as being of intermediate-high mortality risk. Significant improvements were observed in right ventricular (RV) size (RV end-diastolic volume -34±30mL, p = 0.0023; RV end-systolic volume -27±29mL, p = 0.0023), RV mass (Z = -2.63, p = 0.016), RV function (RV ejection fraction 5±8%, p = 0.034) and right atrial size (-6±4cm, p = 0.0023). End-systolic interventricular septal curvature also significantly improved at follow-up (Z = 2.07, p = 0.046), suggesting improvement in RV afterload. Five (28%) patients also had a new-onset (1) or larger (4) pericardial effusion without haemodynamic compromise at follow-up, despite improvements in clinical, biochemical and CMR metrics of PAH. The median increase in pericardial effusion volume was 69% (full range 33%-203%, Z = 2.0, p = 0.043).
CONCLUSION: CMR tracks improvements in right heart chamber size, mass and function along with metrics of RV afterload in patients with PAH receiving sotatercept. The improvements in RV size and function met or exceeded the clinically relevant minimally important differences for these CMR-derived metrics in patients with PAH. Routine interval surveillance with CMR in patients receiving sotatercept will also enable surveillance for the off-target finding of new-onset or worsening pericardial effusions.
MIDER Authors
Affiliations
Department of Rheumatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
Date
2026-03-19
Type
Article
Collections
Citation
J Cardiovasc Magn Reson . 2026 Mar 19:102714