Sex-specific cardiac magnetic resonance pulmonary capillary wedge pressure

Author:

Garg Pankaj12ORCID,Grafton-Clarke Ciaran12,Matthews Gareth12ORCID,Swoboda Peter3,Zhong Liang45,Aung Nay6ORCID,Thomson Ross6,Alabed Samer78ORCID,Demirkiran Ahmet910ORCID,Vassiliou Vassilios S12ORCID,Swift Andrew J7811

Affiliation:

1. Norwich Medical School, University of East Anglia, Norwich Research Park , Rosalind Franklin Road, Norwich NR4 7UQ , UK

2. Department of Cardiology, Norfolk and Norwich University NHS Foundation Trust , Colney Lane, Norwich NR4 7UY , UK

3. Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK

4. National Heart Research Institute Singapore, National Heart Centre Singapore , 5 Hospital Drive , Singapore

5. Signature Programme of Cardiovascular Metabolic and Disorders, Duke-NUS Medical School , 8 College Road , Singapore

6. William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London , London , UK

7. National Institute for Health and Care Research, Sheffield Biomedical Research Centre , Sheffield , UK

8. Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield , Sheffield , UK

9. Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam, Netherlands

10. Department of Cardiology, Kocaeli City Hospital , Kocaeli, Turkey

11. INSIGNEO, Institute for in silico Medicine, University of Sheffield , Sheffield , UK

Abstract

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 and results A derivation cohort of patients with suspected pulmonary hypertension and HF from the Sheffield centre underwent invasive 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.

Funder

National Institute for Health and Care Research

Sheffield Biomedical Research Centre

Wellcome Trust

National Medical Research Council

Department of Health and Social Care

Publisher

Oxford University Press (OUP)

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