AbstractAimsSPARCL1 was recently identified as a biomarker of right ventricular (RV) maladaptation in patients with pulmonary hypertension (PH), and N‐terminal pro‐brain natriuretic protein (NT‐proBNP) is an established biomarker of RV failure in PH. The present study investigated whether NT‐proBNP and SPARCL1 concentrations are associated with load‐independent parameters of RV function and RV‐to‐pulmonary artery (RV–PA) coupling as measured using invasive pressure–volume (PV) loops in the RV.MethodsSPARCL1 and NT‐proBNP were measured in the plasma of patients with idiopathic pulmonary artery hypertension (IPAH, n = 73). Participants without LV or RV abnormalities served as controls (n = 28). All patients underwent echocardiography and right heart catheterization with invasive PV loop measurements.ResultsOur cohort had more females with IPAH than the control group (64% vs. 35%; P = 0.01) and was older [69 (interquartile range, IQR 57–76) vs. 51 (IQR 35–62) years; P < 0.001]. SPARCL1 and NT‐proBNP levels were significantly higher in patients with IPAH as compared with controls (P < 0.0001). Patients with IPAH and maladaptive RV remodelling had higher SPARCL1 and NT‐proBNP concentrations than those with adaptive RV remodelling (P < 0.01). Both SPARCL1 and NT‐proBNP were good predictors of maladaptive RV remodelling in receiver operating characteristic analysis [area under the curve (AUC) (AUCSPARCL1 = 0.75, AUCNT‐proBNP = 0.72, P = 0.36 for AUCSPARCL1 vs. AUCNT‐proBNP]. The combined predictive value of SPARCL1 and NT‐proBNP (AUC 0.78, P < 0.001) for maladaptive RV was numerically higher than that of either SPARCL1 or NT‐proBNP alone (P = 0.16 for AUCSPARCL1 + NT‐proBNP vs. AUCNT‐proBNP and P = 0.18 for AUCSPARCL1 + NT‐proBNP vs. AUCSPARC1). SPARCL1 showed numerically a tendency for a better predictive power than NT‐proBNP for parameters of early maladaptive RV remodelling such as RV ejection fraction < 50% (AUCSPARCL1 = 0.77, AUCNT‐proBNP = 0.67, P = 0.06 for AUCSPARCL1 vs. AUCNT‐proBNP), RV end‐diastolic diameter > 42 mm (AUCSPARCL1 = 0.72, AUCNT‐proBNP = 0.65, P = 0.19 for AUCSPARCL1 vs. AUCNT‐proBNP) and RV end‐systolic volume index RVESVI > 31 mL/m2 (AUCSPARCL1 = 0.78, AUCNT‐proBNP = 0.71, PP = 0.10 for AUCSPARCL1 vs. AUCNT‐proBNP).ConclusionsSPARCL1 and NT‐proBNP are good predictors of maladaptive RV remodelling and RV–PA uncoupling in IPAH patients. SPARCL1 may be a better predictor of early maladaptive RV remodelling than NT‐proBNP.