A cardiovascular magnetic resonance approach for estimating left ventricular filling pressures correlates with established markers of congestion in patients with heart failure, according to findings from the SUGAR-DM-HF trial.
The study, published in the European Journal of Heart Failure, revealed that cardiovascular magnetic resonance–estimated pulmonary capillary wedge pressure (CMR-PCWP) was significantly associated with key heart failure (HF) severity measures, including NT-proBNP levels and ultrasound findings. However, empagliflozin treatment did not produce significant changes in CMR-PCWP compared with placebo.
In this 105-patient randomized controlled trial of patients with HF with reduced ejection fraction (HFrEF) and dysglycemia, researchers found moderate correlations between CMR-PCWP and systolic blood pressure (r = 0.32, P = .0011), log NT-proBNP (r = 0.31, P = .0012), and total B-lines on lung ultrasound (Spearman's rho = 0.34, P < .001). Mean baseline CMR-PCWP was 15.1 mmHg (standard deviation [SD] = 2.5 mmHg), with 50% of patients having values ≥ 15 mmHg. Patients with elevated CMR-PCWP were more often male, had higher body mass index, and exhibited greater NT-proBNP concentrations.
Empagliflozin’s effect on CMR-PCWP was modest. The mean change from baseline to 36 weeks was −0.37 mmHg (95% confidence interval [CI] = −0.78 to 0.05) in the empagliflozin group vs −0.17 mmHg (95% CI = −0.69 to 0.36) in the placebo group, with a placebo-corrected difference of −0.43 mmHg (95% CI = −1.09 to 0.23, P = .20).
"CMR not only enables assessment of cardiac structure and function but also provides a noninvasive assessment of left ventricular (LV) filling pressure," the study authors stated.
The researchers proposed potential clinical applications for CMR-PCWP, including its use as a noninvasive alternative to echocardiography for estimating filling pressure, confirming HF diagnosis, investigating patients without known HF where elevated PCWP may suggest reclassification, and guiding diuretic adjustments.
Study limitations included the small sample size, short follow-up duration of 36 weeks, and the lack of simultaneous TTE and CMR assessments (median timing difference of 7 days). Despite these limitations, CMR-PCWP correlated significantly with imaging and biomarker measures of congestion and holds promise for broader clinical utility.
The SUGAR-DM-HF trial received funding from Boehringer Ingelheim, which had no role in study design, data analysis, or manuscript preparation. Full disclosures are available in the original publication.
