Cardiac magnetic resonance identifies raised left ventricular filling pressure: prognostic implications

Figures

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  Figure 1. Study protocol. This study included patients who were referred to our centre over a 8-year period (2012–2020) for further assessment of breathlessness. Right heart catheterization and cardiac magnetic resonance were performed within 24 h in all cases. Eight hundred and thirty-five patients were included and allocated to derivation (85%) and validation (15%) cohorts. In the validation cohort, we obtained transthoracic echocardiography results within 24 h for comparison with cardiac magnetic resonance. CMR, cardiac magnetic resonance; HF, heart failure; LA, left atrial; LV, left ventricular; PCWP, pulmonary capillary wedge pressure; RHC, right heart catheterization; SOB, shortness of breath; TTE, transthoracic echocardiography.

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  Figure 2. (A,B) Kaplan–Meier survival curves demonstrate prognostic relevance of both invasive and non-invasive pulmonary capillary wedge pressure. (C) Cardiac magnetic resonance-derived pulmonary capillary wedge pressure was non-inferior to an invasively measured pulmonary capillary wedge pressure. (D) After adjusting for all cardiac magnetic resonance variables associated with mortality, cardiac magnetic resonance-modelled pulmonary capillary wedge pressure independently predicted outcomes. (E,F) In the validation cohort, the transthoracic echocardiography and cardiac magnetic resonance models both independently predicted outcomes. Early outcomes were better predicted with the cardiac magnetic resonance model. CMR, cardiac magnetic resonance; PCWP, pulmonary capillary wedge pressure; TTE, transthoracic echocardiography; RHC, right heart catheterization; NAR, Numbers at risk.

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  Figure 3. Proposed decision-making algorithm for the assessment of raised left ventricular filling pressure. -ve, negative; +ve, positive; CMR, cardiovascular magnetic resonance; LVFP, left ventricular filling pressure; SOB, shortness of breath; HF, heart failure; TTE, transthoracic echocardiography