The Left Atrial Area Derived Cardiovascular Magnetic Resonance Left Ventricular Filling Pressure Equation Shows Superiority over Integrated Echocardiography
<i>Background and objectives</i>: 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...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-11-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/59/11/1952 |
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| author | Ciaran Grafton-Clarke Gareth Matthews Rebecca Gosling Peter Swoboda Alexander Rothman Jim M. Wild David G. Kiely Robin Condliffe Samer Alabed Andrew J. Swift Pankaj Garg |
| author_facet | Ciaran Grafton-Clarke Gareth Matthews Rebecca Gosling Peter Swoboda Alexander Rothman Jim M. Wild David G. Kiely Robin Condliffe Samer Alabed Andrew J. Swift Pankaj Garg |
| author_sort | Ciaran Grafton-Clarke |
| collection | DOAJ |
| description | <i>Background and objectives</i>: 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. <i>Materials and methods</i>: 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. <i>Results</i>: 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, <i>p</i> = 0.005), which was not the case for PCWP obtained using RHC or TTE. <i>Conclusions</i>: 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. |
| first_indexed | 2024-03-09T16:38:41Z |
| format | Article |
| id | doaj.art-e7573a6c1cfc4c7ea4a7ad20fc2d1276 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-09T16:38:41Z |
| publishDate | 2023-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-e7573a6c1cfc4c7ea4a7ad20fc2d12762023-11-24T14:54:48ZengMDPI AGMedicina1010-660X1648-91442023-11-015911195210.3390/medicina59111952The Left Atrial Area Derived Cardiovascular Magnetic Resonance Left Ventricular Filling Pressure Equation Shows Superiority over Integrated EchocardiographyCiaran Grafton-Clarke0Gareth Matthews1Rebecca Gosling2Peter Swoboda3Alexander Rothman4Jim M. Wild5David G. Kiely6Robin Condliffe7Samer Alabed8Andrew J. Swift9Pankaj Garg10Department of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Norwich NR4 7UY, UKDepartment of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Norwich NR4 7UY, UKDepartment of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UKDivision of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UKDepartment of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UKDepartment of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UKDepartment of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UKDepartment of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UKDepartment of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UKDepartment of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UKDepartment of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Norwich NR4 7UY, UK<i>Background and objectives</i>: 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. <i>Materials and methods</i>: 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. <i>Results</i>: 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, <i>p</i> = 0.005), which was not the case for PCWP obtained using RHC or TTE. <i>Conclusions</i>: 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.https://www.mdpi.com/1648-9144/59/11/1952cardiovascular magnetic resonanceheart failureechocardiographyhaemodynamic assessmentfilling pressure |
| spellingShingle | Ciaran Grafton-Clarke Gareth Matthews Rebecca Gosling Peter Swoboda Alexander Rothman Jim M. Wild David G. Kiely Robin Condliffe Samer Alabed Andrew J. Swift Pankaj Garg The Left Atrial Area Derived Cardiovascular Magnetic Resonance Left Ventricular Filling Pressure Equation Shows Superiority over Integrated Echocardiography Medicina cardiovascular magnetic resonance heart failure echocardiography haemodynamic assessment filling pressure |
| title | The Left Atrial Area Derived Cardiovascular Magnetic Resonance Left Ventricular Filling Pressure Equation Shows Superiority over Integrated Echocardiography |
| title_full | The Left Atrial Area Derived Cardiovascular Magnetic Resonance Left Ventricular Filling Pressure Equation Shows Superiority over Integrated Echocardiography |
| title_fullStr | The Left Atrial Area Derived Cardiovascular Magnetic Resonance Left Ventricular Filling Pressure Equation Shows Superiority over Integrated Echocardiography |
| title_full_unstemmed | The Left Atrial Area Derived Cardiovascular Magnetic Resonance Left Ventricular Filling Pressure Equation Shows Superiority over Integrated Echocardiography |
| title_short | The Left Atrial Area Derived Cardiovascular Magnetic Resonance Left Ventricular Filling Pressure Equation Shows Superiority over Integrated Echocardiography |
| title_sort | left atrial area derived cardiovascular magnetic resonance left ventricular filling pressure equation shows superiority over integrated echocardiography |
| topic | cardiovascular magnetic resonance heart failure echocardiography haemodynamic assessment filling pressure |
| url | https://www.mdpi.com/1648-9144/59/11/1952 |
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