CMR Left Ventricular Filling Pressure Exhibits Strong Haemodynamic Relevance and Outperforms Echocardiography in Multimodal Heart Failure Assessment
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Authors
Ripley, David
Issue Date
2025
Type
Article
Language
en
Keywords
haemodynamics , cardiology , Left ventricular filling pressure (LVFP) , cardiovascular magnetic resonance (CMR) , echocardiography , N-terminal pro-brain natriuretic peptide (NT-proBNP) , heart failure
Alternative Title
Abstract
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.
Description
Citation
Bana A. et al. (2025) 'CMR Left Ventricular Filling Pressure Exhibits Strong Haemodynamic Relevance and Outperforms Echocardiography in Multimodal Heart Failure Assessment', Journal of Cardiovascular Development and Disease, 12(7):250.
Publisher
License
Journal
Journal of Cardiovascular Development and Disease