Grafton-Clarke, C. orcid.org/0000-0002-8537-0806, Matthews, G., Gosling, R. et al. (8 more authors) (2023) The left atrial area derived cardiovascular magnetic resonance left ventricular filling pressure equation shows superiority over integrated echocardiography. Medicina, 59 (11). 1952. ISSN 1010-660X
Abstract
Background and objectives: Evaluating left ventricular filling pressure (LVFP) plays a crucial role in diagnosing and managing heart failure (HF). While traditional assessment methods involve multi-parametric transthoracic echocardiography (TTE) or right heart catheterisation (RHC), cardiovascular magnetic resonance (CMR) has emerged as a valuable diagnostic tool in HF. This study aimed to assess a simple CMR-derived model to estimate pulmonary capillary wedge pressure (PCWP) in a cohort of patients with suspected or proven heart failure and to investigate its performance in risk-stratifying patients. Materials and methods: A total of 835 patients with breathlessness were evaluated using RHC and CMR and split into derivation (85%) and validation cohorts (15%). Uni-variate and multi-variate linear regression analyses were used to derive a model for PCWP estimation using CMR. The model’s performance was evaluated by comparing CMR-derived PCWP with PCWP obtained from RHC. Results: A CMR-derived PCWP incorporating left ventricular mass and the left atrial area (LAA) demonstrated good diagnostic accuracy. The model correctly reclassified 66% of participants whose TTE was ‘indeterminate’ or ‘incorrect’ in identifying raised filling pressures. On survival analysis, the CMR-derived PCWP model was predictive for mortality (HR 1.15, 95% CI 1.04–1.28, p = 0.005), which was not the case for PCWP obtained using RHC or TTE. Conclusions: The simplified CMR-derived PCWP model provides an accurate and practical tool for estimating PCWP in patients with suspected or proven heart failure. Its predictive value for mortality suggests the ability to play a valuable adjunctive role in echocardiography, especially in cases with unclear echocardiographic assessment.
Metadata
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Copyright, Publisher and Additional Information: | © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). | ||||||||
Keywords: | cardiovascular magnetic resonance; heart failure; echocardiography; haemodynamic assessment; filling pressure | ||||||||
Dates: |
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Institution: | The University of Sheffield | ||||||||
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine and Population Health | ||||||||
Funding Information: |
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Depositing User: | Symplectic Sheffield | ||||||||
Date Deposited: | 14 Nov 2023 14:20 | ||||||||
Last Modified: | 14 Nov 2023 14:20 | ||||||||
Published Version: | http://dx.doi.org/10.3390/medicina59111952 | ||||||||
Status: | Published | ||||||||
Publisher: | MDPI AG | ||||||||
Refereed: | Yes | ||||||||
Identification Number: | https://doi.org/10.3390/medicina59111952 |