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Garg, Pankaj 
ORCID: https://orcid.org/0000-0002-5483-169X, Gosling, Rebecca, Swoboda, Peter, Jones, Rachel, Rothman, Alexander, Wild, Jim M., Kiely, David G., Condliffe, Robin, Alabed, Samer and Swift, Andrew J.
(2022)
Cardiac magnetic resonance identifies raised left ventricular filling pressure: Prognostic implications.
European Heart Journal, 43 (26).
pp. 2511-2522.
ISSN 0195-668X
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Abstract
Aims: Non-invasive imaging is routinely used to estimate left ventricular (LV) filling pressure (LVFP) in heart failure (HF). Cardiovascular magnetic resonance (CMR) is emerging as an important imaging tool for sub-phenotyping HF. However, currently, LVFP cannot be estimated from CMR. This study sought to investigate (i) if CMR can estimate LVFP in patients with suspected HF and (ii) if CMR-modelled LVFP has prognostic power. Methods and results: Suspected HF patients underwent right heart catheterization (RHC), CMR and transthoracic echocardiography (TTE) (validation cohort only) within 24 h of each other. Right heart catheterization measured pulmonary capillary wedge pressure (PCWP) was used as a reference for LVFP. At follow-up, death was considered as the primary endpoint. We enrolled 835 patients (mean age: 65 ± 13 years, 40% male). In the derivation cohort (n = 708, 85%), two CMR metrics were associated with RHC PCWP:LV mass and left atrial volume. When applied to the validation cohort (n = 127, 15%), the correlation coefficient between RHC PCWP and CMR-modelled PCWP was 0.55 (95% confidence interval: 0.41-0.66, P < 0.0001). Cardiovascular magnetic resonance-modelled PCWP was superior to TTE in classifying patients as normal or raised filling pressures (76 vs. 25%). Cardiovascular magnetic resonance-modelled PCWP was associated with an increased risk of death (hazard ratio: 1.77, P < 0.001). At Kaplan-Meier analysis, CMR-modelled PCWP was comparable to RHC PCWP (≥15 mmHg) to predict survival at 7-year follow-up (35 vs. 37%, χ2 = 0.41, P = 0.52). Conclusion: A physiological CMR model can estimate LVFP in patients with suspected HF. In addition, CMR-modelled LVFP has a prognostic role.
| Item Type: | Article |
|---|---|
| Additional Information: | Funding: This work was supported by the National Institute for Health Research (NIHR-RP-R3-12-027) and The Wellcome Trust, (220703/Z/20/Z [https://doi.org/10.35802/220703] and 215799/Z/19/Z). |
| Uncontrolled Keywords: | cardiovascular magnetic resonance,left ventricular filling pressure,right heart catheterization,cardiology and cardiovascular medicine ,/dk/atira/pure/subjectarea/asjc/2700/2705 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 07 Sep 2022 14:30 |
| Last Modified: | 19 Oct 2023 03:24 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/87844 |
| DOI: | 10.1093/eurheartj/ehac207 |
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