Prognostic Value of CMR-Derived Left Ventricular Filling Pressure in Broad Referral Populations

Cardiovascular magnetic resonance (CMR)-derived left ventricle filling pressure (LVFP_cmr) has shown strong correlation with invasively measured values and early promise as a prognostic marker in defined patient populations.

The authors sought to describe associations of LVFP_cmr with future heart failure (HF) outcomes in a large, diverse CMR referral population with stratified analyses by left ventricular (LV) ejection fraction (LVEF) subgroups.

We analyzed consecutively enrolled patients in the Cardiovascular Imaging Registry of Calgary registry between 2015 and 2021 followed for at least 3 years for the occurrence of HF hospitalization, cardiac transplantation, or LV assist device implantation. Subjects completed baseline patient-reported health questionnaires, followed by CMR imaging. Sex-specific LVFP_cmr was calculated.

A total of 9,588 patients were analyzed (median age 57 years; 62% males). Over a median follow-up of 6.4 years, 1,142 patients (12%) experienced the primary outcome. LVFP_cmr was significantly associated with the outcome after adjusting for clinically relevant variables (subdistribution HR: 1.988 for an LVFP_cmr of 18.7 [Q3] vs 14.0 mm Hg [Q1]; 95% CI: 1.659-2.381; P < 0.001). Using a survival-based approach, an optimal cutpoint of 18 mm Hg for LVFP_cmr was identified. LVFP_cmr ≥18 mm Hg remained independently associated with the outcome in the overall cohort, as well as LVEF subgroups. Respective adjusted HR for patients with LVEF <40%, 40 to 50% and >50% were 1.510 (1.216-1.876), 1.582 (1.153-2.171), and 2.865 (2.307-3.559). The latter group demonstrated similar value in patients with vs without coronary disease.

LVFP_cmr is a powerful predictor of future HF outcomes in broad referral populations inclusive of patients with reduced, mildly reduced, and preserved LV function.