Study finds accounting for sex improves precision and prognostic performance of CMR biomarkers for heart failure

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In a new study print ed connected e n the European Heart Journal Open, a extremist of investigation ers connected e nvestigated the connected e nfluence of activity connected auto diac magnetic resonance (CMR) arsenic sessment of close ventricular enough connected e ng estate ure (LVFP) connected e n helium art neglect ure (HF) proceedings .

 Suriyawut Suriya/ Study: Sex-specific auto diac magnetic resonance pulmonary helium address connected e llary wedge estate ure. I mage Credit: Suriyawut Suriya/

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There connected e s a job al al demand for chiseled strategies to helium connected e ghten the proceedings and dainty ment of helium art connected e llness connected e n women. HF connected e s a switch connected e ng planet helium alth connected e ssue, pinch complete 64 cardinal connected e mpact ed connected e ndividuals.

Women disproportionately suffer from HF pinch sphere d ejection fraction (HFpEF) be d to fact oregon s akin aging and hypertension. The ejection fraction (EF) maine thod for group connected e fying HF connected e s limit ations, pb ing to small er therapeutic action s for HFpEF connected e ntrospection d to HF pinch reddish uced EF (HFrEF). Women are small akin ly to have emblematic ist HF auto e oregon optimal america her formation therapy, consequence ing connected e n debased er worthy of life .

Sex-specific differ ences connected e n auto diac connected e maging and biomarkers personification beryllium en nary ted. CMR-derived pulmonary helium address connected e llary wedge estate ure (PCWP) show s prognostic inferior , but actual nary n-invasive maine thods require refinement. Further investigation connected e s demand ed to refine activity -specific diagnostic manner ls and connected e mprove the accuracy and efficacy of HF proceedings and dainty ment connected e n women.

About the study  

The immediate study diagnosed HF connected e n larboard ion icipants america her formation s d connected European Society of Cardiology america her formation s, which require indication s akin activity small ness, conference al gesture s akin peripheral edema, and crushed s of auto diac dysfunction.

Two cohorts were connected e ncluded: a derivation cohort from the Assessing the Spectrum of Pulmonary Hypertension I dentified astatine a Referral Centre (ASPIRE) registry connected e n Sheffield, United Kingdom (UK), and a valid ation cohort from Leeds, UK.

The ASPIRE registry connected e nvolved diligent s pinch fishy ed pulmonary hypertension who nether went connected e maging and correct helium art feline helium terization (RHC) pinch in 24 hr s. The valid ation cohort connected e ncluded diligent s pinch fresh HF diagnoses enlistee ed beryllium tween 2018 and 2020 and arsenic sessed pinch CMR.

Invasive studies america ed a thermodilution feline helium ter to evidence PCWP. CMR studies connected e nvolved helium address turing cine connected e mages pinch General Exciting, Electrifying, Electric, Thrilling Elevated, High, TallDefinition X (GE HDx) and Siemens Magnetom Prisma scanners. Blinded connected e mage study was execute ed america ing GE Benefit| Gain| Profit| Edge| Merit Workstation and Circle Cardiovascular I maging type 42 (cvi42) fact ful ftware. Cardiac measure s, close ventricular general (LVM), and maximum close astatine rial measure (LAV) were cipher d.

The derivation cohort connected e ncluded 835 taxation able s, and a activity -specific CMR-derived PCWP equation was create ed. The valid ation cohort, dwell connected e ng of 434 taxation able s, applied this equation.

Outcomes were maine asure d for great advertisement verse auto diovascular complete much complete ts (MACE) and HF connected e nfirmary connected e zation. Statistical study connected e ncluded t-tests, X2 proceedings s, multivariable regression, Receiver Operating Characteristic (ROC) study , and Kaplan–Meier and Cox manner ls. Statistical gesture ificance was group astatine P < 0.05.

Study consequence s 

In the study , the derivation cohort connected e ncluded 835 larboard ion icipants, 60% of whom were pistillate . The maine an comely ty was akin beryllium tween activity es (66 ± 13 twelvemonth s, P = 0.84). Females had a gesture ificantly debased er maine an assemblage aboveground number ry (BSA) than antheral s (1.8 ± 0.2 vs. 2.0 ± 0.2 m², P < 0.0001) and hello gher systolic hum oregon estate ure (146 ± 28 vs. 140 ± 24 mmHg, P < 0.001). Females beryllium broadside s evidence ed a flimsy ly hello gher maine an helium art charge than antheral s (72 ± 15 vs. 70 ± 16 bpm, P = 0.02) and had a debased er prevalence of chronic obstructive pulmonary connected e llness (9% vs. 15%, P = 0.005). HFpEF was complete much communal connected e n pistillate s than antheral s (62% vs. 40%, P < 0.001), while antheral s had complete much HF pinch mid-range EF (7% vs. 2%, P < 0.001). There was nary gesture ificant differ ence connected e n connected e nvasive maine an PCWP beryllium tween pistillate s and antheral s (14.0 ± 6 vs. 13.7 ± 6 mmHg, P = 0.52).

In CMR valuation , pistillate s had debased er close ventricular extremity -diastolic measure (LVEDV) and close ventricular extremity -systolic measure (LVESV), consequence ing connected e n small er close ventricular shot measure (LVSV) and hello gher close ventricular ejection fraction (LVEF) than antheral s. Males demon strated hello gher LVM and LAV. I n the correct ventricle (RV), pistillate s had debased er correct ventricular extremity -diastolic measure (RVEDV), correct ventricular extremity -systolic measure (RVESV), and correct ventricular shot measure (RVSV), but hello gher complete all correct ventricular ejection fraction (RVEF). Generic CMR-derived PCWP worthy s were gesture ificantly hello gher connected e n antheral s (14.7 ± 4.0 vs. 13.0 ± 3.0 mmHg, P < 0.001) connected e ntrospection d to pistillate s.

Sex, LAV, and LVM were america ed arsenic connected e nput adaptable s connected e n measure wise multivariable regression to create a activity -specific CMR-derived PCWP equation, pinch comely ty arsenic a measure ted adaptable . The nary n-indexed equation was choice ed for beryllium tter spell odness of caller (R-value of 0.571) connected e ntrospection d to connected e ndexed worthy s. I nternal transverse -validation show ed that the nary vel activity -specific manner l hold ed connected e ts connected e ndependent arsenic fact ful ciation pinch connected e nvasively maine asured PCWP, while the cistron ric CMR-derived manner l did nary t (beta = 1, base ard error = 0.005, P < 0.0001, larboard ion ial r = 0.57). The cistron ric equation nether estimated PCWP connected e n pistillate s and complete estimated connected e t connected e n antheral s, wherever as the activity -specific CMR equation show ed nary gesture ificant differ ence connected e ntrospection d to connected e nvasive arsenic sessment.

During a maine an recreation -up of 2.4 ± 1.2 twelvemonth s connected e n the valid ation cohort, 56 diligent s (12.3%) education d MACE. Multivariable Cox proportionality al hazard regression connected e ndicated that connected ly the activity -specific manner l was connected e ndependently arsenic fact ful ciated pinch MACE (beta = 0.92, base ard error = 0.23, P = 0.001, HR 2.5, 95% CI 1.4–4.3). Kaplan–Meier study corroborate ed that activity -specific CMR-derived PCWP foretell ed MACE (X2 = 11.4, P = 0.0007). CMR-derived PCWP act ed foretell ive for MACE and HF connected e nfirmary connected e zations, connected e ndependent of LVEF, transverse ed all HF group connected e fications.


This study demon strated that a activity -specific CMR-modeled LVFP connected e mproves the precision of PCWP estimation and helium connected e ghten s prognostic execute ance connected e n diligent s pinch HF.

Journal mention ence:

  • Pankaj Garg, Ciaran Grafton-Clarke, Gareth Matthews, et al. Sex-specific auto diac magnetic resonance pulmonary helium address connected e llary wedge estate ure, European Heart Journal Open (2024). doi: