Sex-specific cardiac magnetic resonance pulmonary capillary wedge pressure

Pankaj Garg, Ciaran Grafton-Clarke, Gareth Matthews, Peter Swoboda, Liang Zhong, Nay Aung, Ross Thomson, Samer Alabed, Ahmet Demirkiran, Vassilios S. Vassiliou, Andrew J. Swift

Research output: Contribution to journalArticlepeer-review

Abstract

Aims Heart failure (HF) with preserved ejection fraction disproportionately affects women. There are no validated sex-specific tools for HF diagnosis despite widely reported differences in cardiac structure. This study investigates whether sex, as assigned at birth, influences cardiac magnetic resonance (CMR) assessment of left ventricular filling pressure (LVFP), a hallmark of HF agnostic to ejection fraction. Methods A derivation cohort of patients with suspected pulmonary hypertension and HF from the Sheffield centre underwent inva- and results sive right heart catheterization and CMR within 24 h of each other. A sex-specific CMR model to estimate LVFP, measured as pulmonary capillary wedge pressure (PCWP), was developed using multivariable regression. A validation cohort of patients with confirmed HF from the Leeds centre was used to evaluate for the primary endpoints of HF hospitalization and major adverse cardiovascular events (MACEs). Comparison between generic and sex-specific CMR-derived PCWP was undertaken. A total of 835 (60% female) and 454 (36% female) patients were recruited into the derivation and validation cohorts respectively. A sex-specific model incorporating left atrial volume and left ventricular mass was created. The generic CMR PCWP showed significant differences between males and females (14.7 ± 4 vs. 13 ± 3.0 mmHg, P > 0.001), not present with the sex-specific CMR PCWP (14.1 ± 3 vs. 13.8 mmHg, P = 0.3). The sex-specific, but not the generic, CMR PCWP was associated with HF hospitalization (hazard ratio 3.9, P = 0.0002) and MACE (hazard ratio 2.5, P = 0.001) over a mean follow-up period of 2.4 ± 1.2 years. Conclusion Accounting for sex improves precision and prognostic performance of CMR biomarkers for HF.

Original languageEnglish
Article numberoeae038
JournalEuropean Heart Journal Open
Volume4
Issue number3
Early online date15 May 2024
DOIs
Publication statusPublished - May 2024

Keywords

  • CMR
  • Heart failure
  • Sex

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