Association between CMR-derived pulmonary capillary wedge pressure and late gadolinium enhancement in non-ischemic dilated cardiomyopathy

Abstract Background The role of cardiac magnetic resonance imaging (CMR) in evaluating and managing non-ischemic dilated cardiomyopathy (NIDCM) is well recognised. A CMR-derived model for estimating pulmonary capillary wedge pressure (PCWP) has previously been validated in patients suspected of having heart failure (HF). However, the CMR characteristics linked to higher PCWP remains mostly not clarified. Purpose The present study aimed to evaluate the prevalence and association of late gadolinium enhancement (LGE) in NIDCM with increased PCWP. Methods The multicentric cohort study on cardiovascular multimodality imaging evaluation of dilated cardiomyopathy (MAGNIFICENCE) study is a retrospective and prospective, multicentric observational study of patients with newly diagnosed NIDCM aimed to evaluate the prevalence of the main cardiovascular imaging parameters of this cohort of patients. In the present analysis, patients were divided into those with elevated PCWP, defined as PCWP ≥ 15 mmHg, and those with normal PCWP. The CMR-derived PCWP was calculated using the following validated equation: PCWP (CMR) = 6.1352 + (0.07204 × LAV) + (0.02256 × LVM). The primary endpoint was the difference in LGE prevalence between patients with elevated and normal PCWP. The secondary endpoint was the one-year incidence of clinical events (death, HF, stroke or malignant arrhythmias) or ICD implantation. A uni and multivariate logistic regression model was used to assess the association between LGE and CMR-derived PCWP. A uni and multivariate Cox regression model was applied for the predictors of the secondary outcome. A p-value < 0.05 was considered significant. Results Between February 2024 and May 2025, 132 patients were enrolled in the MAGNIFICENCE study. 75 patients were included in the present analysis. 30 patients had a PCWP < 15 mmHg and 45 patients had a PCWP ≥ 15 mmHg. Patients with elevated PCWP had an higher indexed left end-diastolyc ventricular volumes (128 vs 115 ml/m2, p = 0,018), higher indexed left ventricular mass (81 vs 63 g/m2, p = 0,002), lower LVEF% (31 vs 37 %, p= 0,005), higher indexed left atrial volumes (58 vs 32 ml/m2, p < 0,001). LGE was more prevalent in patients with elevated PCWP (64% vs 40% of patients, OR: 2.625; 95% CI: 1.01–6.81; P: 0.047). At one year, the secondary outcome occurred in 34% of patients. After multivariate adjustement, baseline LVEF was the only parameter independentely associated to the outcome (HR 0,90, 95% CI 0,84-0,94, p= 0,001). Patients with LGE and elevated PCWP had the higher risk of the secondary endopoint at one year. (HR 8.714, 95% CI 1.12–67.5, P = 0.038). Conclusions In the present study, the prevalence of LGE was higher in patients with an elevated PCWP. Patients with both LGE and elevated PCWP were at a higher risk of clinical events or ICD implantation within a year.