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

Ross J Thomson; Ciaran Grafton-Clarke; Gareth Matthews; Peter P Swoboda; Andrew J Swift; Alejandro Frangi; Steffen E Petersen; Nay Aung; Pankaj Garg

doi:10.1002/ehf2.15011

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

ESC Heart Fail. 2024 Aug 12. doi: 10.1002/ehf2.15011. Online ahead of print.

Authors

Ross J Thomson^{1

2}, Ciaran Grafton-Clarke^{3

4}, Gareth Matthews^{3

4}, Peter P Swoboda⁵, Andrew J Swift⁶, Alejandro Frangi⁷, Steffen E Petersen^{1

2

8

9}, Nay Aung^{1

2}, Pankaj Garg^{2

3

4}

Affiliations

¹ William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK.
² Barts Heart Centre, St Bartholomew's Hospital, Barts NHS Trust, West Smithfield, London, UK.
³ Norwich Medical School, University of East Anglia, Norwich, UK.
⁴ Norfolk and Norwich University Hospitals, Norwich, UK.
⁵ The Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
⁶ Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK.
⁷ School of Computing, University of Leeds, Leeds, UK.
⁸ Health Data Research UK, London, UK.
⁹ Alan Turing Institute, London, UK.

PMID: 39132877
DOI: 10.1002/ehf2.15011

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.

Abstract

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