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. 2024 Dec;11(6):4148-4159.
doi: 10.1002/ehf2.15011. Epub 2024 Aug 12.

Risk factors for raised left ventricular filling pressure by cardiovascular magnetic resonance: Prognostic insights

Ross J Thomson  1   2 , Ciaran Grafton-Clarke  3   4 , Gareth Matthews  3   4 , Peter P Swoboda  5 , Andrew J Swift  6 , Alejandro Frangi  7 , Steffen E Petersen  1   2   8   9 , Nay Aung  1   2 , Pankaj Garg  2   3   4
Affiliations

Risk factors for raised left ventricular filling pressure by cardiovascular magnetic resonance: Prognostic insights

Ross J Thomson et al. ESC Heart Fail. 2024 Dec.

Abstract

Background: Cardiovascular magnetic resonance (CMR) imaging shows promise in estimating pulmonary capillary wedge pressure (PCWP) non-invasively. At the population level, the prognostic role of CMR-modelled PCWP remains unknown. Furthermore, the relationship between CMR-modelled PCWP and established risk factors for cardiovascular disease has not been well characterized.

Objective: The main aim of this study was to investigate the prognostic value of CMR-modelled PCWP at the population level.

Methods: Employing data from the imaging substudy of the UK Biobank, a very large prospective population-based cohort study, CMR-modelled PCWP was calculated using a model incorporating left atrial volume, left ventricular mass and sex. Logistic regression explored the relationships between typical cardiovascular risk factors and raised CMR-modelled PCWP (≥15 mmHg). Cox regression was used to examine the impact of typical risk factors and CMR-modelled PCWP on heart failure (HF) and major adverse cardiovascular events (MACE).

Results: Data from 39 163 participants were included in the study. Median age of all participants was 64 years (inter-quartile range: 58 to 70), and 47% were males. Clinical characteristics independently associated with raised CMR-modelled PCWP included hypertension [odds ratio (OR) 1.57, 95% confidence interval (CI) 1.44-1.70, P < 0.001], body mass index (BMI) [OR 1.57, 95% CI 1.52-1.62, per standard deviation (SD) increment, P < 0.001], male sex (OR 1.37, 95% CI 1.26-1.47, P < 0.001), age (OR 1.33, 95% CI 1.27-1.41, per decade increment, P < 0.001) and regular alcohol consumption (OR 1.10, 95% CI 1.02-1.19, P = 0.012). After adjusting for potential confounders, CMR-modelled PCWP was independently associated with incident HF [hazard ratio (HR) 2.91, 95% CI 2.07-4.07, P < 0.001] and MACE (HR 1.48, 95% CI 1.16-1.89, P = 0.002).

Conclusions: Raised CMR-modelled PCWP is an independent risk factor for incident HF and MACE. CMR-modelled PCWP should be incorporated into routine CMR reports to guide HF diagnosis and further management.

Keywords: MRI; cardiovascular magnetic resonance; heart failure epidemiology; left ventricular filling pressure.

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Conflict of interest statement

P. G. is a clinical advisor for Pie Medical Imaging and Medis Medical Imaging. S. E. P. is a consultant to Circle Cardiovascular Imaging. R. J. T. is an advisor to Panacea Innovation. All other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Forest plot showing the relationships between baseline characteristics and raised CMR‐modelled PCWP, as determined by multivariable logistic regression (≥15 mmHg). BMI, body mass index; CI, confidence interval; CMR, cardiovascular magnetic resonance; OR, odds ratio; PCWP, pulmonary capillary wedge pressure; SD, standard deviation.
Figure 2
Figure 2
Relationships between CMR‐modelled PCWP and age modelled using a cubic spline of age with nine knots, adjusted for all covariables. Hypertension shifts the curves similarly in both female and male UK Biobank participants, and the age dependency with an inflection point at age 70 is similar in both sexes. CMR, cardiovascular magnetic resonance; PCWP, pulmonary capillary wedge pressure.
Figure 3
Figure 3
Forest plot showing the adjusted hazard ratios for incident outcomes across a range of exposures, as determined by multivariable Cox regression modelling: (A) HF; (B) MACE. BMI, body mass index; CI, confidence interval; CMR, cardiovascular magnetic resonance; LV, left ventricular; MACE, major adverse cardiovascular event; OR, odds ratio; PCWP, pulmonary capillary wedge pressure.
Figure 4
Figure 4
Kaplan–Meier survival curves stratified by CMR‐modelled PCWP. (A) Incident heart failure; (B) MACE. CMR, cardiovascular magnetic resonance; MACE, major adverse cardiovascular event; PCWP, pulmonary capillary wedge pressure.
Figure 5
Figure 5
Cox survival curves (line, 95% confidence interval: shaded) stratified by the presence or absence of elevated CMR‐modelled PCWP. The left panel shows unadjusted survival for the two groups, from univariable regression Cox models, while the right panel shows survival adjusted for confounding variables using multivariable Cox models. (A) Incident heart failure; (B) adjusted incident heart failure; (C) MACE; (D) adjusted MACE. CMR, cardiovascular magnetic resonance; MACE, major adverse cardiovascular event; PCWP, pulmonary capillary wedge pressure.
Figure 6
Figure 6
Risk prediction chart (nomogram) for raised left ventricular filling pressure. The nomogram shows the risk of elevated CMR‐modelled PCWP for different combinations of systolic blood pressure, age, sex, and presence/absence of obesity. The colour scale represents absolute risk, from low (green) to high (red). The number in each box is the relative risk for an individual with that combination of risk factors, compared with the lowest‐risk individual of their sex. CMR, cardiovascular magnetic resonance; PCWP, pulmonary capillary wedge pressure.
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