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Thomson RJ, Grafton-Clarke C, Matthews G, Swoboda PP, Swift AJ, Frangi A, Petersen SE, Aung N, Garg P. Risk factors for raised left ventricular filling pressure by cardiovascular magnetic resonance: Prognostic insights. ESC Heart Fail 2024. [PMID: 39132877 DOI: 10.1002/ehf2.15011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 06/19/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024] Open
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.
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Affiliation(s)
- Ross J Thomson
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts NHS Trust, West Smithfield, London, UK
| | - Ciaran Grafton-Clarke
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals, Norwich, UK
| | - Gareth Matthews
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals, Norwich, UK
| | - Peter P Swoboda
- The Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | | | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts NHS Trust, West Smithfield, London, UK
- Health Data Research UK, London, UK
- Alan Turing Institute, London, UK
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts NHS Trust, West Smithfield, London, UK
| | - Pankaj Garg
- Barts Heart Centre, St Bartholomew's Hospital, Barts NHS Trust, West Smithfield, London, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals, Norwich, UK
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2
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Crea F. Cardiac imaging: focus on safety, optimal delivery, and risk stratification. Eur Heart J 2023; 44:4725-4728. [PMID: 38038647 DOI: 10.1093/eurheartj/ehad773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Grafton-Clarke C, Matthews G, Gosling R, Swoboda P, Rothman A, Wild JM, Kiely DG, Condliffe R, Alabed S, Swift AJ, Garg P. The Left Atrial Area Derived Cardiovascular Magnetic Resonance Left Ventricular Filling Pressure Equation Shows Superiority over Integrated Echocardiography. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1952. [PMID: 38004001 PMCID: PMC10672763 DOI: 10.3390/medicina59111952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Abstract
Background and objectives: 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. Materials and methods: 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. Results: 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, p = 0.005), which was not the case for PCWP obtained using RHC or TTE. Conclusions: 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.
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Affiliation(s)
- Ciaran Grafton-Clarke
- Department of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Norwich NR4 7UY, UK; (C.G.-C.)
- School of Medicine, University of East Anglia, Norwich NR4 7TJ, UK
| | - Gareth Matthews
- Department of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Norwich NR4 7UY, UK; (C.G.-C.)
- School of Medicine, University of East Anglia, Norwich NR4 7TJ, UK
| | - Rebecca Gosling
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
| | - Peter Swoboda
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Alexander Rothman
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
- NIHR Biomedical Research Centre, Sheffield, S10 2JF, UK
| | - Jim M. Wild
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
- NIHR Biomedical Research Centre, Sheffield, S10 2JF, UK
| | - David G. Kiely
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
- NIHR Biomedical Research Centre, Sheffield, S10 2JF, UK
| | - Robin Condliffe
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
- NIHR Biomedical Research Centre, Sheffield, S10 2JF, UK
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
| | - Andrew J. Swift
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
- NIHR Biomedical Research Centre, Sheffield, S10 2JF, UK
| | - Pankaj Garg
- Department of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Norwich NR4 7UY, UK; (C.G.-C.)
- School of Medicine, University of East Anglia, Norwich NR4 7TJ, UK
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Grafton‐Clarke C, Garg P, Swift AJ, Alabed S, Thomson R, Aung N, Chambers B, Klassen J, Levelt E, Farley J, Greenwood JP, Plein S, Swoboda PP. Cardiac magnetic resonance left ventricular filling pressure is linked to symptoms, signs and prognosis in heart failure. ESC Heart Fail 2023; 10:3067-3076. [PMID: 37596895 PMCID: PMC10567675 DOI: 10.1002/ehf2.14499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/03/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023] Open
Abstract
AIMS Left ventricular filling pressure (LVFP) can be estimated from cardiovascular magnetic resonance (CMR). We aimed to investigate whether CMR-derived LVFP is associated with signs, symptoms, and prognosis in patients with recently diagnosed heart failure (HF). METHODS AND RESULTS This study recruited 454 patients diagnosed with HF who underwent same-day CMR and clinical assessment between February 2018 and January 2020. CMR-derived LVFP was calculated, as previously, from long- and short-axis cines. CMR-derived LVFP association with symptoms and signs of HF was investigated. Patients were followed for median 2.9 years (interquartile range 1.5-3.6 years) for major adverse cardiovascular events (MACE), defined as the composite of cardiovascular death, HF hospitalization, non-fatal stroke, and non-fatal myocardial infarction. The mean age was 62 ± 13 years, 36% were female (n = 163), and 30% (n = 135) had raised LVFP. Forty-seven per cent of patients had an ejection fraction < 40% during CMR assessment. Patients with raised LVFP were more likely to have pleural effusions [hazard ratio (HR) 3.2, P = 0.003], orthopnoea (HR 2.0, P = 0.008), lower limb oedema (HR 1.7, P = 0.04), and breathlessness (HR 1.7, P = 0.01). Raised CMR-derived LVFP was associated with a four-fold risk of HF hospitalization (HR 4.0, P < 0.0001) and a three-fold risk of MACE (HR 3.1, P < 0.0001). In the multivariable model, raised CMR-derived LVFP was independently associated with HF hospitalization (adjusted HR 3.8, P = 0.0001) and MACE (adjusted HR 3.0, P = 0.0001). CONCLUSIONS Raised CMR-derived LVFP is strongly associated with symptoms and signs of HF. In addition, raised CMR-derived LVFP is independently associated with subsequent HF hospitalization and MACE.
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Affiliation(s)
- Ciaran Grafton‐Clarke
- Norwich Medical SchoolUniversity of East AngliaNorwich Research ParkNorwichNR4 7UQUK
- Norfolk and Norwich University Hospitals NHS Foundation TrustNorfolkUK
| | - Pankaj Garg
- Norwich Medical SchoolUniversity of East AngliaNorwich Research ParkNorwichNR4 7UQUK
- Norfolk and Norwich University Hospitals NHS Foundation TrustNorfolkUK
- Department of Infection, Immunity and Cardiovascular DiseaseUniversity of Sheffield Medical School and Sheffield Teaching Hospitals NHS TrustSheffieldUK
| | - Andrew J. Swift
- Department of Infection, Immunity and Cardiovascular DiseaseUniversity of Sheffield Medical School and Sheffield Teaching Hospitals NHS TrustSheffieldUK
- Department of Clinical RadiologySheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular DiseaseUniversity of Sheffield Medical School and Sheffield Teaching Hospitals NHS TrustSheffieldUK
| | - Ross Thomson
- William Harvey Research Institute, NIHR Barts Biomedical Research CentreQueen Mary University of LondonLondonUK
- Barts Heart CentreSt Bartholomew's Hospital, Barts NHS TrustLondonUK
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research CentreQueen Mary University of LondonLondonUK
- Barts Heart CentreSt Bartholomew's Hospital, Barts NHS TrustLondonUK
| | - Bradley Chambers
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Joel Klassen
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Eylem Levelt
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Jonathan Farley
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - John P. Greenwood
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Peter P. Swoboda
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
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Backhaus SJ, Schuster A. Atrial functional assessment at rest and during exercise stress in left ventricular diastolic dysfunction. Eur Heart J 2022; 43:3493-3494. [PMID: 35929610 DOI: 10.1093/eurheartj/ehac418] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Crea F. Cardiac magnetic resonance: challenges, opportunities, and developments. Eur Heart J 2022; 43:2427-2431. [PMID: 35793813 DOI: 10.1093/eurheartj/ehac355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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