CMR Left Ventricular Filling Pressure Exhibits Strong Haemodynamic Relevance and Outperforms Echocardiography in Multimodal Heart Failure Assessment

Figures

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  Figure 1. Relationship between CMR-derived LVFP or pulmonary capillary wedge pressure and key cardiac biomarkers including panel (a), N-terminal pro-brain natriuretic peptide (NT-proBNP), (b) ratio of early mitral inflow velocity to early diastolic annular velocity (E/e’), (c) interventricular septal thickness in diastole (IVSd), and (d) left atrial volume index (LAVI) across mean CMR PCWP values of 16, 18, and 23 mmHg. Bar graphs display mean ± standard deviation. Statistical significance was determined by ANOVA, with p-values indicated. Abbreviations: CMR, cardiac magnetic resonance; PCWP, pulmonary capillary wedge pressure; NT-proBNP, N-terminal pro-brain natriuretic peptide; E/e’, ratio of early mitral inflow velocity to early diastolic annular velocity; IVSd, interventricular septal thickness in diastole; LAVI, left atrial volume index.

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  Figure 2. Correlation between CMR-derived LVFP and echocardiographic indices. The bar graph illustrates Spearman’s rank correlation coefficients (rho) with 95% confidence intervals for key echocardiographic parameters, ranked by correlation strength. Positive correlations (red) indicate increasing values with higher LVFP, while negative correlations (blue) indicate decreasing values. Statistical significance is denoted as p < 0.05 (*), p < 0.01 (**), and p < 0.001 (***). Abbreviations: CMR, cardiac magnetic resonance; LVFP, left ventricular filling pressure; LAVI, left atrial volume index; IVSd, interventricular septal thickness in diastole; E/e’, ratio of early mitral inflow velocity to early diastolic annular velocity; TRV, tricuspid regurgitation velocity; A, late diastolic mitral flow velocity; E, early diastolic mitral flow velocity; E/A, ratio of early to late diastolic mitral flow velocity; Lateral e’, lateral mitral annular velocity; Septal e’, septal mitral annular velocity.

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  Figure 3. Associations between NT-proBNP with CMR-derived LVFP and echocardiographic E/e’. (Top) Scatter plots with logarithmic regression lines and 95% confidence intervals show correlations of NT-proBNP with (left) CMR LVFP (r = 0.47, p < 0.001) and (right) E/e’ (r = 0.41, p < 0.001). (Bottom) Receiver operating characteristic (ROC) curves illustrate the diagnostic accuracy of (left) CMR LVFP and (right) E/e’ for predicting NT-proBNP >400 pg/mL. Abbreviations: NT-proBNP, N-terminal pro-brain natriuretic peptide; CMR, cardiac magnetic resonance; LVFP, left ventricular filling pressure; E/e’, ratio of early mitral inflow velocity to early diastolic annular velocity; AUC, area under the curve.

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  Figure 4. Multimodal assessment of LVFP and myocardial characteristics in an 80-year-old male with shortness of breath on exertion and NYHA class II symptoms. Panel (a–d): Echocardiographic assessment demonstrates an enlarged LA, an E velocity of 89.5 cm/sec, and an E/e’ ratio of 12.3, placing LVFP in an indeterminate range. Panel (e–g): CMR showed left ventricular hypertrophy and preserved LVEF, similar to echocardiography. (h,i): Native T1 mapping and extracellular volume (ECV) fraction mapping reveal regions of increased values, suggesting subtle myocardial fibrosis. (j): Late gadolinium enhancement (LGE) imaging shows no noticeable scar. Abbreviations: SOBOE, shortness of breath on exertion; NYHA, New York Heart Association; LA, left atrium; LVFP, left ventricular filling pressure; LVEF, left ventricular ejection fraction; CMR, cardiac magnetic resonance; ECV, extracellular volume; LGE, late gadolinium enhancement.