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32 Sex-specific cardiac magnetic resonance pulmonary capillary wedge pressure model predicts outcomes in heart failure: a multi-centre study
  1. Ciaran Grafton-Clarke1,
  2. Gareth Matthews1,2,
  3. Rui Li1,
  4. Hosamadin Assadi1,2,
  5. Peter Swoboda3,
  6. Chris Sawh1,2,
  7. Vassilios S Vassiliou1,2,
  8. Andrew J Swift4,
  9. Pankaj Garg1,2
  1. 1Norwich Medical School, University of East Anglia, Norwich, UK
  2. 2Norfolk and Norwich University NHS Trust, Norwich, UK
  3. 3University of Leeds, Leeds, UK
  4. 4University of Sheffield, Sheffield, UK


Introduction Non-invasive imaging is routinely used to estimate left ventricular (LV) filling pressure (LVFP) in heart failure (HF). Cardiovascular magnetic resonance (CMR) is emerging as an important imaging tool for sub-phenotyping HF and estimating pulmonary capillary wedge pressure (PCWP), a surrogate for LVFP.1

This research sought to investigate the following questions:

1) Does sex (male/female) influence CMR-derived PCWP?

2) Compared to a previously validated generic CMR-derived PCWP model,1 does the use of a sex-specific model improve precision?

3) Is a novel sex-specific CMR-modelled PCWP prognostically significant?

Materials and Methods A derivation cohort (Norwich) involving patients with suspected HF underwent invasive right heart catheterisation and CMR within 24 hours of each other ( figure 1A ). This cohort was used to develop a sex-specific CMR model to estimate PCWP. The sex-specific CMR-derived PCWP model was developed using stepwise multivariate regression, using CMR variables significantly associated with PCWP during multivariate linear regression.

A validation cohort (Sheffield) of patients with confirmed heart failure underwent CMR ( figure 1B ) and was used to evaluate for the primary end-points of heart failure hospitalisation and MACE (composite cardiovascular death, HF hospitalisation, non- fatal stroke and myocardial infarction). A comparison in the prognostic performance between the generic model and the novel sex-specific CMR-derived PCWP models was performed.

Results 835 subjects were recruited from the Sheffield centre (derivation), and 454 subjects were recruited from the Leeds centre (validation).

Sex (male/female) does influence CMR-derived PCWP, since left atrial volume (LAV) and left ventricular mass (LVM) are higher in men ( figure 1C ). A novel sex- specific model incorporating LAV and LVM was created:

Sex-specific PCWP = 5.8 + (0.075*LAV) + (0.05*LVM) – (1.99*sex) [F=0; M=1]

Applying the generic CMR model resulted in significant differences in PCWP between males and females (14.7±4 versus 13±3 mmHg, p>0.001). Using the sex- specific model, CMR-derived PCWP was comparable between males and females (14.1±3 versus 13.8 mmHg, p=0.3), highlighting its excellent performance ( figure 1D ). Notably, there was no difference in invasive PCWP assessment between males and females (13.7±6 versus 14.0±6 mmHg).

In the validation cohort, the sex-specific model was associated with HF hospitalisation (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 ( figure 1E and F ). This was not the case for the generic CMR-derived PCWP.

Conclusion A sex-specific CMR-derived PCWP model improves precision and prognostication in heart failure compared to a generic CMR-derived PCWP model.

Acknowledgements Nil.


  1. Garg P, Gosling R, Swoboda P, et al. Cardiac magnetic resonance identifies raised left ventricular filling pressure: prognostic implications. Eur Heart J. 2022:ehac207.

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