TY - JOUR
T1 - Sex-specific cardiac magnetic resonance pulmonary capillary wedge pressure
AU - Garg, Pankaj
AU - Grafton-Clarke, Ciaran
AU - Matthews, Gareth
AU - Swoboda, Peter
AU - Zhong, Liang
AU - Aung, Nay
AU - Thomson, Ross
AU - Alabed, Samer
AU - Demirkiran, Ahmet
AU - Vassiliou, Vassilios S.
AU - Swift, Andrew J.
N1 - Funding Information: This study or research is funded by the National Institute for Health and Care Research (NIHR) Sheffield Biomedical Research Centre (NIHR203321*), the Wellcome Trust (220703/Z/20/Z and 215799/Z/19/ Z), and the National Medical Research Council (NMRC/OFIRG/0018/ 2016). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care, Wellcome Trust, or NMRC.
PY - 2024/5
Y1 - 2024/5
N2 - 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.
AB - 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.
KW - CMR
KW - Heart failure
KW - Sex
UR - http://www.scopus.com/inward/record.url?scp=85193537275&partnerID=8YFLogxK
U2 - 10.1093/ehjopen/oeae038
DO - 10.1093/ehjopen/oeae038
M3 - Article
AN - SCOPUS:85193537275
SN - 2752-4191
VL - 4
JO - European Heart Journal Open
JF - European Heart Journal Open
IS - 3
M1 - oeae038
ER -