CMR Left Ventricular Filling Pressure Exhibits Strong Haemodynamic Relevance and Outperforms Echocardiography in Multimodal Heart Failure Assessment

CMR Left Ventricular Filling Pressure Exhibits Strong Haemodynamic Relevance and Outperforms Echocardiography in Multimodal Heart Failure Assessment

Background: Left ventricular filling pressure (LVFP) is pivotal in heart failure management, yet non-invasive assessment remains challenging. While echocardiography is the first line, cardiovascular magnetic resonance (CMR) offers enhanced accuracy. This study evaluates the interplay between CMR-der...

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Main Authors: Aradhai Bana, Rui Li, Zia Mehmood, Craig Rogers, Ciaran Grafton-Clarke, Tiya Bali, David Hall, Mustapha Jamil, Liandra Ramachenderam, Uwais Dudhiya, Hilmar Spohr, Victoria Underwood, Rebekah Girling, Bahman Kasmai, Sunil Nair, David P. Ripley, Gareth Matthews, Pankaj Garg
Format: Article
Language:English
Published: MDPI AG 2025-06-01
Series:Journal of Cardiovascular Development and Disease
Subjects:
N-terminal pro-brain natriuretic peptide
prospective studies
pulmonary capillary wedge pressure
area under curve
sex characteristics
heart failure
Online Access:https://www.mdpi.com/2308-3425/12/7/250
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Summary:Background: Left ventricular filling pressure (LVFP) is pivotal in heart failure management, yet non-invasive assessment remains challenging. While echocardiography is the first line, cardiovascular magnetic resonance (CMR) offers enhanced accuracy. This study evaluates the interplay between CMR-derived LVFP and echocardiography, focusing on sex differences and correlations with N-terminal pro-brain natriuretic peptide (NT-proBNP). Methods: In this prospective study, 222 patients with CMR-derived LVFP > 14 mmHg underwent transthoracic echocardiography (TTE) and CMR. Sex-specific CMR equations (incorporating left atrial volume and ventricular mass) were used to estimate pulmonary capillary wedge pressure (PCWP). Correlations between imaging parameters and NT-proBNP were assessed. Results: CMR-derived LVFP showed no sex-based differences (<i>p</i> = 0.3143), unlike echocardiographic indices: women had higher E/e′ (<i>p</i> < 0.0001) and lower lateral mitral annular velocities (<i>p</i> = 0.0159). CMR-derived LVFP correlated strongly with NT-proBNP (r = 0.47, <i>p</i> < 0.0001), outperforming E/e′ (r = 0.41). Stratification by CMR PCWP tertiles revealed higher NT-proBNP (<i>p</i> = 0.0003), left atrial volumes (<i>p</i> < 0.0001), and septal thickness (<i>p</i> < 0.0001) in the highest tertiles. CMR-derived LVFP demonstrated superior diagnostic accuracy (AUC = 0.754 vs. 0.740 for E/e′) in identifying elevated NT-proBNP (>400 pg/mL). Sex-independent CMR measures contrasted with echocardiography, where parameters like left atrial volume varied by sex (<i>p</i> = 0.012). Conclusions: CMR-derived LVFP is a robust, sex-independent biomarker strongly linked to NT-proBNP, offering superior diagnostic performance over echocardiography. Its integration with echocardiographic indices enhances the non-invasive assessment of cardiac filling pressures, advocating a synergistic imaging approach to refine heart failure management.
ISSN:2308-3425

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