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. 2023 Nov 4;59(11):1952.
doi: 10.3390/medicina59111952.

The Left Atrial Area Derived Cardiovascular Magnetic Resonance Left Ventricular Filling Pressure Equation Shows Superiority over Integrated Echocardiography

Ciaran Grafton-Clarke  1   2 , Gareth Matthews  1   2 , Rebecca Gosling  3 , Peter Swoboda  4 , Alexander Rothman  3   5 , Jim M Wild  3   5 , David G Kiely  3   5 , Robin Condliffe  3   5 , Samer Alabed  3 , Andrew J Swift  3   5 , Pankaj Garg  1   2
Affiliations

The Left Atrial Area Derived Cardiovascular Magnetic Resonance Left Ventricular Filling Pressure Equation Shows Superiority over Integrated Echocardiography

Ciaran Grafton-Clarke et al. Medicina (Kaunas). .

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.

Keywords: cardiovascular magnetic resonance; echocardiography; filling pressure; haemodynamic assessment; heart failure.

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Conflict of interest statement

P.G. is a clinical advisor for Pie Medical Imaging and Medis Medical Imaging. All other authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
A simplified model of CMR-derived PCWP incorporating left ventricular mass and left atrial area. Red contour indicates the endocardium and the green contour indicates the epicardium. The purple contour indicate the left atrial endocardial wall.
Figure 2
Figure 2
Panel (a): Receiver operator characteristics curve for CMR-modelling PCWP against measured PCWP 15 mmHg to identify raised left ventricular filling pressures. Panel (b): Receiver operator characteristics curve for integrated TTE PCWP against measured PCWP 15 mmHg to identify raised left ventricular filling pressures.
Figure 3
Figure 3
A simplified CMR-derived PCWP model correctly reclassified 66% of participants where TTE failed to identify participants with ‘elevated’ filling pressures.
Figure 4
Figure 4
Panel (A): Cox’s proportional hazard regression within the validation cohort demonstrates that a simplified CMR-derived PCWP model predicts mortality, whereas predicting PCWP by RHC and TTE does not. Panel (B): Kaplan–Meier survival curves within the validation cohort demonstrate the prognostic significance of a simplified CMR-derived PCWP model, whereas assessment using TTE does not.
See this image and copyright information in PMC

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