Sex-specific cardiac magnetic resonance pulmonary capillary wedge pressure

Garg, Pankaj ORCID: https://orcid.org/0000-0002-5483-169X, Grafton-Clarke, Ciaran ORCID: https://orcid.org/0000-0002-8537-0806, Matthews, Gareth ORCID: https://orcid.org/0000-0001-8353-4806, Swoboda, Peter, Zhong, Liang, Aung, Nay, Thomson, Ross, Alabed, Samer, Demirkiran, Ahmet, Vassiliou, Vassilios S. ORCID: https://orcid.org/0000-0002-4005-7752 and Swift, Andrew J. (2024) Sex-specific cardiac magnetic resonance pulmonary capillary wedge pressure. European Heart Journal Open, 4 (3). ISSN 2752-4191

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Abstract

Aims Heart failure (HF) with preserved ejection fraction disproportionately affects women. There are no validated sex-specific tools for HF diagnosis despite widely reported differences in cardiac structure. This study investigates whether sex, as assigned at birth, influences cardiac magnetic resonance (CMR) assessment of left ventricular filling pressure (LVFP), a hallmark of HF agnostic to ejection fraction. Methods A derivation cohort of patients with suspected pulmonary hypertension and HF from the Sheffield centre underwent inva- and results sive right heart catheterization and CMR within 24 h of each other. A sex-specific CMR model to estimate LVFP, measured as pulmonary capillary wedge pressure (PCWP), was developed using multivariable regression. A validation cohort of patients with confirmed HF from the Leeds centre was used to evaluate for the primary endpoints of HF hospitalization and major adverse cardiovascular events (MACEs). Comparison between generic and sex-specific CMR-derived PCWP was undertaken. A total of 835 (60% female) and 454 (36% female) patients were recruited into the derivation and validation cohorts respectively. A sex-specific model incorporating left atrial volume and left ventricular mass was created. The generic CMR PCWP showed significant differences between males and females (14.7 ± 4 vs. 13 ± 3.0 mmHg, P > 0.001), not present with the sex-specific CMR PCWP (14.1 ± 3 vs. 13.8 mmHg, P = 0.3). The sex-specific, but not the generic, CMR PCWP was associated with HF hospitalization (hazard ratio 3.9, P = 0.0002) and MACE (hazard ratio 2.5, P = 0.001) over a mean follow-up period of 2.4 ± 1.2 years. Conclusion Accounting for sex improves precision and prognostic performance of CMR biomarkers for HF.

Item Type: Article
Additional Information: Funding Information: This study or research is funded by the National Institute for Health and Care Research (NIHR) Sheffield Biomedical Research Centre (NIHR203321*), the Wellcome Trust (220703/Z/20/Z and 215799/Z/19/ Z), and the National Medical Research Council (NMRC/OFIRG/0018/ 2016). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care, Wellcome Trust, or NMRC. Publisher Copyright: © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
Uncontrolled Keywords: cmr,heart failure,sex,cardiology and cardiovascular medicine,surgery ,/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
Faculty of Science > Research Groups > Norwich Epidemiology Centre
Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre
Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health
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Depositing User: LivePure Connector
Date Deposited: 28 May 2024 09:30
Last Modified: 28 May 2024 09:31
URI: https://ueaeprints.uea.ac.uk/id/eprint/95312
DOI: 10.1093/ehjopen/oeae038

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