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Prognostic Value of Left-Ventricular Filling Pressure Estimated by Cardiovascular Magnetic Resonance in Patients With
Weibo Li1, Kairui Bo1, Zhen Zhou1
1Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China.
Insights
Left-ventricular filling pressure estimated using cardiovascular magnetic resonance (LVFPcmr) independently predicts major adverse cardiac events (MACEs) after acute ST-segment elevation myocardial infarction (ASTEMI). This noninvasive measure aids in post-percutaneous coronary intervention risk stratification.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Diastology
Background:
- Left-ventricular filling pressure (LVFP) by cardiovascular magnetic resonance (CMR) assesses diastolic function noninvasively.
- Prognostic value of LVFPcmr is established in heart failure, but data post-acute ST-segment elevation myocardial infarction (ASTEMI) are limited.
Purpose of the Study:
- Evaluate the diagnostic and prognostic implications of LVFPcmr in patients following ASTEMI.
- Assess the utility of LVFPcmr for risk stratification post-percutaneous coronary intervention (PCI).
Main Methods:
- Included 296 ASTEMI patients undergoing CMR post-PCI.
- Assessed major adverse cardiac events (MACEs) including death, reinfarction, and heart failure.
- Employed univariable/multivariable Cox regression, ROC, and Kaplan-Meier analyses for prognostic evaluation.
Main Results:
- 38 patients (12.84%) experienced MACEs during median follow-up (1563 days).
- Higher LVFPcmr was significantly associated with MACEs (p < 0.001), with an optimal cutoff of 14.30 mmHg.
- Each 1 mmHg increase in LVFPcmr raised MACE risk (HR 1.31, p < 0.001), robust in multivariable models (HR 1.25, p < 0.01).
Conclusions:
- LVFPcmr independently predicts long-term MACEs after ASTEMI.
- Supports the use of LVFPcmr for risk stratification in ASTEMI patients post-PCI.
Background:
Left-ventricular filling pressure estimated using cardiovascular magnetic resonance (LVFPcmr) provides a noninvasive measure of diastolic function and has demonstrated prognostic value comparable to invasive assessment in heart failure populations. However, data on LVFPcmr in patients following acute ST-segment elevation myocardial infarction (ASTEMI) are limited. Thus, this study aimed to evaluate the diagnostic and prognostic implications of LVFPcmr in a cohort of patients with ASTEMI.
Methods:
This study included 296 patients with ASTEMI who underwent cardiovascular magnetic resonance (CMR) after percutaneous coronary intervention (PCI). The primary clinical endpoint was major adverse cardiac events (MACEs), defined as a composite of death, reinfarction, and heart failure. Univariable and multivariable Cox regression analyses were used to determine the association between LVFPcmr and MACEs. Receiver operating characteristic curve and Kaplan-Meier analyses were performed to evaluate the prognostic value of LVFPcmr in patients with ASTEMI.
Results:
During a median follow-up of 1563 days (interquartile range: 1442-1714 days), 38 patients (12.84%) experienced MACEs. These patients exhibited significantly higher CMR-derived LVFPcmr values than those without MACEs (14.57 [13.17-15.99] vs. 13.30 [12.05-14.51] mmHg; p < 0.001). Moreover, the Youden index identified an optimal LVFPcmr cutoff of 14.30 mmHg for high-risk classification (p < 0.001). In univariable Cox regression analysis, each 1 mmHg increase in LVFPcmr was associated with a significantly higher risk of MACEs (hazard ratio [HR]: 1.31; 95% confidence interval [CI]: 1.14-1.51; p < 0.001). This association remained robust in multivariable models after adjustment for baseline covariates, left-ventricular ejection fraction, and infarct size (% of LV mass) (HR: 1.25 per 1 mmHg increase; 95% CI, 1.07-1.46; p < 0.01). The multivariable regression model yielded a Harrell C-index of 0.77, indicating strong discriminative ability for predicting MACEs.
Conclusions:
LVFPcmr independently predicts long-term MACEs after ASTEMI, supporting the use of this approach in post-PCI risk stratification.
