Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7UQ, UK.
Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK.
ESC Heart Fail. 2023 Oct;10(5):3067-3076. doi: 10.1002/ehf2.14499. Epub 2023 Aug 19.
Left ventricular filling pressure (LVFP) can be estimated from cardiovascular magnetic resonance (CMR). We aimed to investigate whether CMR-derived LVFP is associated with signs, symptoms, and prognosis in patients with recently diagnosed heart failure (HF).
This study recruited 454 patients diagnosed with HF who underwent same-day CMR and clinical assessment between February 2018 and January 2020. CMR-derived LVFP was calculated, as previously, from long- and short-axis cines. CMR-derived LVFP association with symptoms and signs of HF was investigated. Patients were followed for median 2.9 years (interquartile range 1.5-3.6 years) for major adverse cardiovascular events (MACE), defined as the composite of cardiovascular death, HF hospitalization, non-fatal stroke, and non-fatal myocardial infarction. The mean age was 62 ± 13 years, 36% were female (n = 163), and 30% (n = 135) had raised LVFP. Forty-seven per cent of patients had an ejection fraction < 40% during CMR assessment. Patients with raised LVFP were more likely to have pleural effusions [hazard ratio (HR) 3.2, P = 0.003], orthopnoea (HR 2.0, P = 0.008), lower limb oedema (HR 1.7, P = 0.04), and breathlessness (HR 1.7, P = 0.01). Raised CMR-derived LVFP was associated with a four-fold risk of HF hospitalization (HR 4.0, P < 0.0001) and a three-fold risk of MACE (HR 3.1, P < 0.0001). In the multivariable model, raised CMR-derived LVFP was independently associated with HF hospitalization (adjusted HR 3.8, P = 0.0001) and MACE (adjusted HR 3.0, P = 0.0001).
Raised CMR-derived LVFP is strongly associated with symptoms and signs of HF. In addition, raised CMR-derived LVFP is independently associated with subsequent HF hospitalization and MACE.
左心室充盈压（LVFP）可通过心血管磁共振（CMR）进行评估。本研究旨在探讨在近期诊断为心力衰竭（HF）的患者中，CMR 衍生的 LVFP 是否与症状和预后相关。
本研究纳入了 2018 年 2 月至 2020 年 1 月期间行同日 CMR 和临床评估的 454 名 HF 患者。采用先前的方法从长轴和短轴电影中计算 CMR 衍生的 LVFP。研究了 CMR 衍生的 LVFP 与 HF 症状和体征的关系。中位随访 2.9 年（四分位距 1.5-3.6 年），随访终点为主要不良心血管事件（MACE），定义为心血管死亡、HF 住院、非致死性卒中及非致死性心肌梗死的复合终点。患者的平均年龄为 62±13 岁，36%为女性（n=163），30%（n=135）的 LVFP 升高。47%的患者在 CMR 评估时射血分数<40%。LVFP 升高的患者更有可能出现胸腔积液[风险比（HR）3.2，P=0.003]、端坐呼吸（HR 2.0，P=0.008）、下肢水肿（HR 1.7，P=0.04）和呼吸困难（HR 1.7，P=0.01）。CMR 衍生的 LVFP 升高与 HF 住院风险增加 4 倍相关（HR 4.0，P<0.0001），与 MACE 风险增加 3 倍相关（HR 3.1，P<0.0001）。在多变量模型中，CMR 衍生的 LVFP 升高与 HF 住院（调整后的 HR 3.8，P=0.0001）和 MACE（调整后的 HR 3.0，P=0.0001）独立相关。
CMR 衍生的 LVFP 与 HF 的症状和体征密切相关。此外，CMR 衍生的 LVFP 升高与随后的 HF 住院和 MACE 独立相关。
