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07. Syncope and Bradycardia
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Critical appraisal of a non-invasive model to derive pulmonary capillary wedge pressure from Cardiac Magnetic Resonance in Heart Failure patients – look before you jump
Session:
Comunicações Orais - Sessão 22 - Ressonância Magnética e Cardiologia Nuclear
Speaker:
Sérgio Maltês
Congress:
CPC 2023
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.6 Cross-Modality and Multi-Modality Imaging Topics
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sérgio Maltês; Mariana Sousa Paiva; Rita Reis Santos; Bruno ML Rocha; Gonçalo JL Cunha; Joana Pereira; Rita Carvalho; Miguel Domingues; Cláudia Silva; Sara Guerreiro; Pedro Freitas; João Abecasis; Miguel Mendes; António M Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Background</u>: Cardiac magnetic resonance (CMR) is increasingly used to assess heart failure (HF) patients, but the hemodynamic information it provides is somewhat limited. Recently, a large study proposed a physiological model to estimate pulmonary capillary wedge pressure from CMR data (CMR-PCWP). Our goals were to assess the clinical determinants and correlates of this new tool, as well as to determine its prognostic significance in HF patients.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Methodology</u><span style="color:#222222">: Consecutive patients with HF and left ventricular ejection fraction (LVEF) <50% were identified in a single center CMR registry. Standard measurements of left ventricular mass (LVM) and biplanar left atrial volume (LAV) were used to calculate CMR-PCWP as per the proposed model: 6.1352 + (0.07204 x LAV [mL]) + (0.02256 x LVM [g]). We evaluated the correlation between CMR-PCWP and other parameters, including lung water density (LWD- lung-to-liver signal ratio in parasagittal HASTE images). The prognostic significance of CMR-PCWP was assessed using a composite endpoint of all-cause death or HF hospitalization.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:#222222">Results</span></u><span style="color:#222222">: A total of 578 patients (mean age 63±14years, 72% male, mean LVEF 34 ± 10%, 45% ischemic etiology) were included. Mean CMR-PCWP was 16±4mmHg, with 298 patients (52%) showing values ≥15mmHg. Patients with elevated CMR-PWCP were older, had lower LVEF and RVEF, higher ventricular volumes and higher LWD values (Table 1, figure A). CMR-PCWP showed a moderate correlation with LWD (Spearman’s R 0.42, p <0.001) and a reasonable discriminative power to identify those with elevated LWD (AUC ROC curve 0.695, p<0.001). During a median follow-up of 25 (13–51) months, there were 69 deaths and 72 HF hospitalizations. CMR-PCWP was an independent predictor of the primary endpoint (HR 1.08, 95% CI 1.04-1.12, p<0.001), alongside with age (HR 1.02 per year, 95% CI 1.004–1.040, p=0.014), NYHA (HR 1.34 per class, 95% CI 1.07–1.68, p=0.010) and NT-proBNP (HR 1.004 per 100 pg/mL, 95% CI 1.002–1.006, p<0.001). However, a very strong correlation was found between CMR-PCWP and LAV, where 95% of the variance (R<sup>2</sup>=0.947, figure B) of CMR-PCWP is explained solely by LAV. The discriminative power of CMR-PCWP and LAV to predict events was similar (AUC 0.67 vs 0.67, p-value for comparison = 0.724).</span></span></span></p> <p><u><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:#222222">Conclusion</span></span></span></u><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:#222222">: In this cohort of patients with HF and LVEF<50%, CMR-derived PCWP seems to be a mere surrogate of LAV and is unlikely to add any useful diagnostic or prognostic information to other already established CMR measurements</span></span></span></p>
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