Left atrial expansion index measured with cardiovascular magnetic resonance estimates pulmonary capillary wedge pressure in dilated cardiomyopathy.

IF 4.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiovascular Magnetic Resonance Pub Date : 2023-11-30 DOI:10.1186/s12968-023-00977-2

Davide Genovese, Laura De Michieli, Giacomo Prete, Manuel De Lazzari, Marco Previtero, Donato Mele, Carlo Cernetti, Giuseppe Tarantini, Sabino Iliceto, Martina Perazzolo Marra

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Abstract

Background: Pulmonary capillary wedge pressure (PCWP) assessment is fundamental for managing dilated cardiomyopathy (DCM) patients. Although cardiovascular magnetic resonance (CMR) has become the gold-standard imaging technique for evaluating cardiac chamber volume and function, PCWP is not routinely assessed with CMR. Therefore, this study aimed to validate the left atrial expansion index (LAEI), a LA reservoir function parameter able to estimate filling pressure with echocardiography, as a novel CMR-measured parameter for non-invasive PCWP estimation in DCM patients.

Methods: We performed a retrospective, single-center, cross-sectional study. We included electively admitted DCM patients referred to our tertiary center for further diagnostic evaluation that underwent a clinically indicated right heart catheterization (RHC) and CMR within 24 h. PCWP invasively measured during RHC was used as the reference. LAEI was calculated from CMR-measured LA maximal and minimal volumes as LAEI = ( (LAVmax-LAVmin)/LAVmin) × 100.

Results: We enrolled 126 patients (47 ± 14 years; 68% male; PCWP = 17 ± 9.3 mmHg) randomly divided into derivation (n = 92) and validation (n = 34) cohorts with comparable characteristics. In the derivation cohort, the log-transformed (ln) LAEI showed a strong linear correlation with PCWP (r = 0.81, p < 0.001) and remained a strong independent PCWP determinant over clinical and conventional CMR parameters. Moreover, lnLAEI accurately identified PCWP ≥ 15 mmHg (AUC = 0.939, p < 0.001), and the optimal cut-off identified (lnLAEI ≤ 3.85) in the derivation cohort discriminated PCWP ≥ 15 mmHg with 82.4% sensitivity, 88.2% specificity, and 85.3% accuracy in the validation cohort. Finally, the equation PCWP = 52.33- (9.17xlnLAEI) obtained from the derivation cohort predicted PCWP (-0.1 ± 5.7 mmHg) in the validation cohort.

Conclusions: In this cohort of DCM patients, CMR-measured LAEI resulted in a novel and useful parameter for non-invasive PCWP evaluation.

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用心血管磁共振测量左心房扩张指数估计扩张型心肌病的肺毛细血管楔压。

背景:肺毛细血管楔压(PCWP)评估是治疗扩张型心肌病(DCM)患者的基础。尽管心血管磁共振(CMR)已成为评估心室容量和功能的金标准成像技术，但PCWP并未常规使用CMR进行评估。因此，本研究旨在验证左心房扩张指数(LAEI)，一个能够通过超声心动图估计充盈压力的LA储层功能参数，作为一种新的cmr测量参数，用于估计DCM患者的无创PCWP。方法:我们进行了一项回顾性、单中心、横断面研究。我们纳入了选择性入院的DCM患者，这些患者在24小时内接受了临床指示的右心导管(RHC)和CMR。在RHC期间有创测量的PCWP作为参考。LAEI由cmr测量的LA最大和最小体积计算为LAEI = ((LAVmax-LAVmin)/LAVmin) × 100。结果:126例患者(47±14岁;男性68%;PCWP = 17±9.3 mmHg)随机分为具有可比特征的衍生队列(n = 92)和验证队列(n = 34)。在衍生队列中，对数转换(ln) LAEI与PCWP显示出很强的线性相关性(r = 0.81, p)。结论:在该DCM患者队列中，cmr测量的LAEI为无创评估PCWP提供了一种新颖而有用的参数。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiovascular Magnetic Resonance 医学-核医学

CiteScore

10.90

自引率

12.50%

发文量

审稿时长

6-12 weeks

期刊介绍： Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.