Article Impact Level: HIGH Data Quality: STRONG Summary of ESC Heart Failure, ehf2.15011. https://doi.org/10.1002/ehf2.15011 Dr. Ross J. Thomson et al.
Points
- Researchers used data from the UK Biobank to examine the prognostic value of non-invasively estimated pulmonary capillary wedge pressure (PCWP) via cardiovascular magnetic resonance (CMR) imaging.
- The study involved 39,163 predominantly middle-aged participants, with nearly equal gender distribution, to assess the relationship between CMR-modelled PCWP and cardiovascular outcomes.
- Elevated CMR-modelled PCWP (≥15 mmHg) was independently associated with hypertension, higher BMI, male sex, older age, and regular alcohol consumption.
- Higher CMR-modelled PCWP was significantly associated with increased risks of incident heart failure (HF) and major adverse cardiovascular events (MACE).
- Incorporating CMR-modelled PCWP into routine CMR assessments could improve diagnostic accuracy for heart failure and enhance management strategies for cardiovascular risk.
Summary
In a substantial study leveraging data from the UK Biobank’s imaging substudy, researchers investigated the prognostic value of pulmonary capillary wedge pressure (PCWP) estimated non-invasively through cardiovascular magnetic resonance (CMR) imaging. This analysis focused on determining the relationship between CMR-modelled PCWP, cardiovascular disease risk factors, and its predictive capacity for heart failure (HF) and major adverse cardiovascular events (MACE). By integrating left atrial volume, left ventricular mass, and sex into a model, the CMR-modelled PCWP provided insights into the cardiovascular status of a large cohort, examining its efficacy in predicting long-term cardiovascular outcomes.
The study involved data from 39,163 participants, predominantly middle-aged (median age 64 years, interquartile range 58 to 70), with a near-equal gender distribution (47% male). Analysis using logistic regression identified several factors independently associated with elevated CMR-modelled PCWP (≥15 mmHg), including hypertension (odds ratio [OR] 1.57, 95% confidence interval [CI] 1.44–1.70, P < 0.001), higher body mass index (BMI) (OR 1.57, 95% CI 1.52–1.62, per standard deviation increment, P < 0.001), male sex (OR 1.37, 95% CI 1.26–1.47, P < 0.001), older 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).
Upon adjusting for various confounders, CMR-modelled PCWP was significantly associated with increased risks of 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). These findings suggest that elevated CMR-modelled PCWP independently predicts severe cardiovascular outcomes. Incorporating CMR-modelled PCWP into routine CMR reports could enhance the diagnostic accuracy for HF and optimize management strategies, potentially altering the clinical approach to evaluating and mitigating cardiovascular risk.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/ehf2.15011
References Thomson, R. J., Grafton‐Clarke, C., Matthews, G., Swoboda, P. P., Swift, A. J., Frangi, A., Petersen, S. E., Aung, N., & Garg, P. (2024). Risk factors for raised left ventricular filling pressure by cardiovascular magnetic resonance: Prognostic insights. ESC Heart Failure, ehf2.15011. https://doi.org/10.1002/ehf2.15011
