Risk factors for raised left ventricular filling pressure by cardiovascular magnetic resonance: Prognostic insights

Abstract

Background: Cardiovascular magnetic resonance (CMR) imaging shows promise in estimating pulmonary capillary wedge pressure (PCWP) non-invasively. At the population level, the prognostic role of CMR-modelled PCWP remains unknown. Furthermore, the relationship between CMR-modelled PCWP and established risk factors for cardiovascular disease has not been well characterized. Objective: The main aim of this study was to investigate the prognostic value of CMR-modelled PCWP at the population level. Methods: Employing data from the imaging substudy of the UK Biobank, a very large prospective population-based cohort study, CMR-modelled PCWP was calculated using a model incorporating left atrial volume, left ventricular mass and sex. Logistic regression explored the relationships between typical cardiovascular risk factors and raised CMR-modelled PCWP (≥15 mmHg). Cox regression was used to examine the impact of typical risk factors and CMR-modelled PCWP on heart failure (HF) and major adverse cardiovascular events (MACE). Results: Data from 39 163 participants were included in the study. Median age of all participants was 64 years (inter-quartile range: 58 to 70), and 47% were males. Clinical characteristics independently associated with raised CMR-modelled PCWP included hypertension [odds ratio (OR) 1.57, 95% confidence interval (CI) 1.44–1.70, P < 0.001], body mass index (BMI) [OR 1.57, 95% CI 1.52–1.62, per standard deviation (SD) increment, P < 0.001], male sex (OR 1.37, 95% CI 1.26–1.47, P < 0.001), 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). After adjusting for potential confounders, CMR-modelled PCWP was independently associated with 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). Conclusions: Raised CMR-modelled PCWP is an independent risk factor for incident HF and MACE. CMR-modelled PCWP should be incorporated into routine CMR reports to guide HF diagnosis and further management.