Cardiac magnetic resonance left ventricular filling pressure is linked to symptoms, signs and prognosis in heart failure

Abstract

AimsLeft ventricular filling pressure (LVFP) can be estimated from cardiovascular magnetic resonance (CMR). We aimed to investigate whether CMR‐derived LVFP is associated with signs, symptoms, and prognosis in patients with recently diagnosed heart failure (HF).Methods and resultsThis study recruited 454 patients diagnosed with HF who underwent same‐day CMR and clinical assessment between February 2018 and January 2020. CMR‐derived LVFP was calculated, as previously, from long‐ and short‐axis cines. CMR‐derived LVFP association with symptoms and signs of HF was investigated. Patients were followed for median 2.9 years (interquartile range 1.5–3.6 years) for major adverse cardiovascular events (MACE), defined as the composite of cardiovascular death, HF hospitalization, non‐fatal stroke, and non‐fatal myocardial infarction. The mean age was 62 ± 13 years, 36% were female (n = 163), and 30% (n = 135) had raised LVFP. Forty‐seven per cent of patients had an ejection fraction < 40% during CMR assessment. Patients with raised LVFP were more likely to have pleural effusions [hazard ratio (HR) 3.2, P = 0.003], orthopnoea (HR 2.0, P = 0.008), lower limb oedema (HR 1.7, P = 0.04), and breathlessness (HR 1.7, P = 0.01). Raised CMR‐derived LVFP was associated with a four‐fold risk of HF hospitalization (HR 4.0, P < 0.0001) and a three‐fold risk of MACE (HR 3.1, P < 0.0001). In the multivariable model, raised CMR‐derived LVFP was independently associated with HF hospitalization (adjusted HR 3.8, P = 0.0001) and MACE (adjusted HR 3.0, P = 0.0001).ConclusionsRaised CMR‐derived LVFP is strongly associated with symptoms and signs of HF. In addition, raised CMR‐derived LVFP is independently associated with subsequent HF hospitalization and MACE.

Improved Interpretation of Pulmonary Artery Wedge Pressures through Left Atrial Volumetry—A Cardiac Magnetic Resonance Imaging Study

“…Increased PAWP levels, whether invasively measured or non-invasively estimated, have repeatedly been linked to a worse prognosis in heart failure [ 38 , 39 ]. Studies have shown that an increase in PAWP is more closely associated with symptom burden and a worse prognosis than the elevation of LVEDP [ 40 ].…”

Sex-specific cardiac magnetic resonance pulmonary capillary wedge pressure

“… 14 , 18 It is superior to transthoracic echocardiography in correctly classifying patients as having ‘normal’ or ‘raised’ filling pressures and can better determine the risk of cardiovascular death. Other large HF cohort studies have demonstrated the clinical significance of raised CMR-derived PCWP, 19 showing that elevated CMR-derived PCWP is strongly associated with symptoms (orthopnoea, breathlessness) and signs of HF (pleural effusions, lower limb oedema). Furthermore, raised CMR-derived PCWP is independently associated with subsequent HF hospitalization and major adverse cardiovascular events (MACEs).…”

“…Furthermore, raised CMR-derived PCWP is independently associated with subsequent HF hospitalization and major adverse cardiovascular events (MACEs). 19 In addition to its role in HF, CMR-derived PCWP can also be used to measure acute and dynamic changes in preloading conditions on the LV during adenosine-administered first-pass perfusion CMR, where it has been observed to rise significantly. 20 …”