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Rapid Fire Abstracts

Rapid Fire 09- CMR Analysis (including machine learning) III

Cardiac features in patients with hemodynamically acquired left ventricular end diastolic pressure (RF_SA_436)

Saturday, February 1, 2025
9:40 AM – 9:50 AM East Coast USA Time
Location: Blue Room PreFunction - Kiosk 1
Background: Left ventricular end diastolic pressure (LVEDP) is a critical biomarker used to assess LV loading conditions and to diagnose heart failure in patients with preserved or reduced LV ejection fraction (LVEF). In this study, we sought to understand the similarities and differences of cardiac features assessed by cardiac MRI (CMR) across levels of increasing severity of LVEDP between subjects that had normal or reduced LVEF.

Methods: This retrospective cohort study included consecutive subjects who underwent invasive hemodynamic testing and were referred for clinical CMR evaluation within 3 days. We compared cardiac features between categories of LVEDP severity (LVEDP ≤12 mmHg, 12< LVEDP < 18 mmHg, and LVEDP ≥18 mmHg) within strata of normal (≥50%) or reduced ( < 50%) LVEF. ANOVA and chi-square statistics were used to assess the differences between subgroups for continuous and categorical variables, respectively. Linear regression and Cochran-Mantel-Haenszel tests were used to assess trends for continuous and categorical variables, respectively.

Results: Among 724 included in our sample, the average age was 64 ± 13 years, 63% were male, 47% had hypertension, 25% had diabetes, and the average BMI was 28.9 ± 5.5 kg/m2. Obesity was associated with significantly increased LVEDP irrespective of LVEF (p < 0.001 for both subgroups). There were 348 (48%) patients with normal LVEF and 376 (52%) with reduced LVEF. Increased LV mass and left atrial volume (LAV max) were significantly associated with worsening LVEDP categories (p-values =0.0241 and 0.0478, respectively) among those with normal LVEF (Table 1).  Similar associations were also observed in subjects with reduced LVEF, among whom we additionally observed associations of increase LV and RV volumes and a decrease in RVEF with worsening LVEDP categories (all p-values < 0.05). There was also an increase in the prevalence of late gadolinium enhancement across worsening LVEDP categories (Table 2).

Conclusion: Obesity is an important risk of significantly elevated LVEDP independent of LVEF. The characteristic adverse cardiac remodeling of increased LV mass and LA volume is an important association with elevated LVEDP shared by subjects with both reserved and reduced LVEF. Adverse RV remodeling corresponding to elevated LVEDP is more significant in reduced than those with preserved LVEF.