Wedge Pressure Rather Than Left Ventricular End-Diastolic Pressure Predicts Outcome in Heart Failure With Preserved Ejection Fraction

This study sought to compare the prognostic power of left ventricular end-diastolic pressure (LVEDP) and pulmonary arterial wedge pressure (PAWP) in heart failure with preserved ejection fraction (HFpEF). It is broadly accepted that direct measurement of LVEDP in HFpEF more robustly reflects left ve...

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Bibliographic Details
Published in:JACC. Heart failure 2017-11, Vol.5 (11), p.795-801
Main Authors: Mascherbauer, Julia, Zotter-Tufaro, Caroline, Duca, Franz, Binder, Christina, Koschutnik, Matthias, Kammerlander, Andreas A., Aschauer, Stefan, Bonderman, Diana
Format: Article
Language:English
Subjects:
Aged
Cardiac Catheterization
diffusing capacity of carbon monoxide
Echocardiography
Female
filling pressures
Follow-Up Studies
Heart Failure - diagnosis
Heart Failure - physiopathology
heart failure with preserved ejection fraction
Heart Ventricles - diagnostic imaging
Heart Ventricles - physiopathology
Humans
Magnetic Resonance Imaging, Cine
Male
Middle Aged
outcome
Prospective Studies
Pulmonary Wedge Pressure - physiology
Retrospective Studies
Stroke Volume - physiology
Ventricular Function, Left - physiology
Ventricular Pressure - physiology
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Summary:This study sought to compare the prognostic power of left ventricular end-diastolic pressure (LVEDP) and pulmonary arterial wedge pressure (PAWP) in heart failure with preserved ejection fraction (HFpEF). It is broadly accepted that direct measurement of LVEDP in HFpEF more robustly reflects left ventricular hemodynamics than PAWP. A total of 173 consecutive HFpEF patients were prospectively enrolled. Of these, 152 patients fulfilled registry inclusion criteria. Study participants underwent clinical evaluation, lung function tests, echocardiography, cardiac magnetic resonance, coronary angiography, and invasive hemodynamic assessments with PAWP and LVEDP measurements in 1 procedure. The study endpoint was defined as hospitalization for heart failure or cardiac death. A modest pressure difference (2.0 ± 4.4 mm Hg) was observed between PAWP (21.5 ± 5.6 mm Hg) and LVEDP (19.5 ± 5.2 mm Hg) at baseline. After a mean follow-up of 23.5 ± 21.3 months, PAWP was predictive of outcome (p = 0.010), whereas LVEDP was not (p = 0.261) by Kaplan-Meier curves. By multivariate regression analysis, diffusion capacity of carbon monoxide (DLCO) was the only parameter that was independently related to the pressure difference between PAWP and LVEDP. When patients were stratified according to DLCO between ≤45% and >45%, those in the low DLCO group were found to have a more pronounced pressure drop between PAWP and LVEDP (3.1 ± 4.8 mm Hg vs. 0.8 ± 3.8 mm Hg, respectively; p = 0.031) and to be in more advanced disease stages. Our data indicate that PAWP but not LVEDP is associated with outcome in HFpEF. A more pronounced difference between PAWP and LVEDP and more advanced disease is found in patients with low DLCO. [Display omitted]
ISSN:2213-1779
2213-1787
DOI:10.1016/j.jchf.2017.08.005