▎ WuXi AppTec content team editor
Heart failure is the leading cause of death from cardiovascular disease, and the annual incidence is on the rise, creating a huge social and economic burden.
Currently, the best way to diagnose heart failure is an invasive assessment, but this diagnosis carries some risk to patients. Non-invasive echocardiography is often used as an alternative diagnosis, but it can be erroneous in up to 50% of cases.
Recently, a new study published in the European Heart Journal shows that magnetic resonance imaging (MRI) is superior to echocardiography in diagnosing heart failure and is a powerful tool for predicting patient prognosis, including death. The paper notes that using MRI scans to detect heart failure could revolutionize the way the disease is diagnosed.
Screenshot source: European Heart Journal
The study included 835 patients (mean age: 65±13 years, 40% male), including signs or symptoms of heart failure, > 18 years of age. Patients with suspected heart failure underwent right heart catheterization, cardiovascular MRI, and transthoracic echocardiography within 24 hours (validated cohort only).
Pulmonary capillary wedge pressure (PCWP) measured by right heart catheterization serves as a reference index for left ventricular filling pressure (LVFP) in patients. The primary endpoint of the study was a patient death event that occurred during follow-up.
Cardiac MRI recognizes elevated left ventricular filling pressure and has a prognostic effect
In the derivation cohort (n=708, 85%), two cardiovascular MRI indicators were associated with PCWP: left ventricular mass and left atrial volume.
When applied to the validation cohort (n=127, 15%), the correlation coefficient between PCWP assessed based on right heart catheterization and PCWP estimated using MRI detection was 0.55 (95% CI: 0.41-0.66, P
PcWP estimated using cardiovascular MRI was superior to transthoracic echocardiography (76% vs. 25%) in classifying patients as normal or elevated filling pressure. In addition, patients with PCWP were estimated to have a 77% increased risk of death using cardiovascular MRI (risk ratio: 1.77, P
In the Kaplan-Meier analysis, PCWP assessed using cardiovascular MRI and PCWP (≥15 mmHg) based on right heart catheterization were predicted to have comparable survival rates at 7-year follow-up (35% vs. 37%, χ2=0.41, P=0.52).
Studies have shown that a physiological assessment model based on cardiovascular MRI can effectively predict LVFP in patients with suspected heart failure. In addition, the LVFP value obtained by this model method has a prognostic effect.
Image credit: 123RF
Cardiac MRI changes the diagnosis of heart failure and may be generally used
Dr Pankaj Garg, principal investigator at the University of East Anglia's Norwich Medical School, noted that "heart failure is a terrible condition caused by rising pressure within the heart. The best way to diagnose heart failure is invasive testing, but it is difficult to operate and carries some risk. Cardiac ultrasonography is commonly used clinically to assess cardiac pressure. However, it is not very accurate. We wondered if MRI could provide a better option. ”
"Our study shows that cardiac MRI is superior to echocardiography in predicting intracardiac pressure. Nearly 71 percent of patients who failed to measure blood pressure correctly by echocardiography received correct blood pressure measurements through cardiac MRI. ”
Speaking about the significance of the study, he further noted that "these findings will reduce the need for invasive assessments." Not only is this cost-effective, but it also reduces the risk for the patient, as a cardiac MRI scan is a completely noninvasive test. ”
"By determining the key parameters — left atrial volume and left ventricular mass — we created an equation to derive cardiac pressure non-invasively. This simple equation can be applied to any center in the world that conducts cardiac MRI tests. Regarding the application of clinical practice, he suggests, "The next step is to test the application in other hospitals to assess the clinical benefits it brings to patients and reduce the need for invasive testing." ”