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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MDPI AG
2025-06-01
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| author | 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 |
| author_facet | 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 |
| author_sort | Aradhai Bana |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-ddd0d92b4c8246e79786bc4c82617ab8 |
| institution | DOAJ |
| issn | 2308-3425 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | MDPI AG |
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| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj-art-ddd0d92b4c8246e79786bc4c82617ab82025-08-20T02:45:49ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252025-06-0112725010.3390/jcdd12070250CMR Left Ventricular Filling Pressure Exhibits Strong Haemodynamic Relevance and Outperforms Echocardiography in Multimodal Heart Failure AssessmentAradhai Bana0Rui Li1Zia Mehmood2Craig Rogers3Ciaran Grafton-Clarke4Tiya Bali5David Hall6Mustapha Jamil7Liandra Ramachenderam8Uwais Dudhiya9Hilmar Spohr10Victoria Underwood11Rebekah Girling12Bahman Kasmai13Sunil Nair14David P. Ripley15Gareth Matthews16Pankaj Garg17Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UKNorwich Medical School, University of East Anglia, Norwich NR4 7TJ, UKNorwich Medical School, University of East Anglia, Norwich NR4 7TJ, UKNorfolk and Norwich University Teaching Hospitals, Norwich NR4 7UY, UKNorwich Medical School, University of East Anglia, Norwich NR4 7TJ, UKNorwich Medical School, University of East Anglia, Norwich NR4 7TJ, UKNorfolk and Norwich University Teaching Hospitals, Norwich NR4 7UY, UKNorfolk and Norwich University Teaching Hospitals, Norwich NR4 7UY, UKNorfolk and Norwich University Teaching Hospitals, Norwich NR4 7UY, UKNorfolk and Norwich University Teaching Hospitals, Norwich NR4 7UY, UKNorfolk and Norwich University Teaching Hospitals, Norwich NR4 7UY, UKNorfolk and Norwich University Teaching Hospitals, Norwich NR4 7UY, UKNorfolk and Norwich University Teaching Hospitals, Norwich NR4 7UY, UKNorfolk and Norwich University Teaching Hospitals, Norwich NR4 7UY, UKNorfolk and Norwich University Teaching Hospitals, Norwich NR4 7UY, UKDepartment of Cardiology, Northumbria Healthcare NHS Foundation Trust, Northumbria Specialist Emergency Care Hospital, Cramlington NE29 8NH, UKNorwich Medical School, University of East Anglia, Norwich NR4 7TJ, UKNorwich Medical School, University of East Anglia, Norwich NR4 7TJ, UKBackground: 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.https://www.mdpi.com/2308-3425/12/7/250N-terminal pro-brain natriuretic peptideprospective studiespulmonary capillary wedge pressurearea under curvesex characteristicsheart failure |
| spellingShingle | 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 CMR Left Ventricular Filling Pressure Exhibits Strong Haemodynamic Relevance and Outperforms Echocardiography in Multimodal Heart Failure Assessment Journal of Cardiovascular Development and Disease N-terminal pro-brain natriuretic peptide prospective studies pulmonary capillary wedge pressure area under curve sex characteristics heart failure |
| title | CMR Left Ventricular Filling Pressure Exhibits Strong Haemodynamic Relevance and Outperforms Echocardiography in Multimodal Heart Failure Assessment |
| title_full | CMR Left Ventricular Filling Pressure Exhibits Strong Haemodynamic Relevance and Outperforms Echocardiography in Multimodal Heart Failure Assessment |
| title_fullStr | CMR Left Ventricular Filling Pressure Exhibits Strong Haemodynamic Relevance and Outperforms Echocardiography in Multimodal Heart Failure Assessment |
| title_full_unstemmed | CMR Left Ventricular Filling Pressure Exhibits Strong Haemodynamic Relevance and Outperforms Echocardiography in Multimodal Heart Failure Assessment |
| title_short | CMR Left Ventricular Filling Pressure Exhibits Strong Haemodynamic Relevance and Outperforms Echocardiography in Multimodal Heart Failure Assessment |
| title_sort | cmr left ventricular filling pressure exhibits strong haemodynamic relevance and outperforms echocardiography in multimodal heart failure assessment |
| topic | N-terminal pro-brain natriuretic peptide prospective studies pulmonary capillary wedge pressure area under curve sex characteristics heart failure |
| url | https://www.mdpi.com/2308-3425/12/7/250 |
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