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
{"title":"CMR左心室充盈压力显示出强大的血流动力学相关性，在多模式心力衰竭评估中优于超声心动图。","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","doi":"10.3390/jcdd12070250","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":"12 7","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"CMR Left Ventricular Filling Pressure Exhibits Strong Haemodynamic Relevance and Outperforms Echocardiography in Multimodal Heart Failure Assessment.\",\"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\",\"doi\":\"10.3390/jcdd12070250\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":15197,\"journal\":{\"name\":\"Journal of Cardiovascular Development and Disease\",\"volume\":\"12 7\",\"pages\":\"\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-06-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cardiovascular Development and Disease\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3390/jcdd12070250\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiovascular Development and Disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3390/jcdd12070250","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
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-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 (p = 0.3143), unlike echocardiographic indices: women had higher E/e' (p < 0.0001) and lower lateral mitral annular velocities (p = 0.0159). CMR-derived LVFP correlated strongly with NT-proBNP (r = 0.47, p < 0.0001), outperforming E/e' (r = 0.41). Stratification by CMR PCWP tertiles revealed higher NT-proBNP (p = 0.0003), left atrial volumes (p < 0.0001), and septal thickness (p < 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 (p = 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.
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