Pulmonary Artery Wedge Pressure and LVEDP Variance in Pulmonary Hypertension

Left ventricular end diastolic pressure (LVEDP) measurement with standard right heart catheterization (RHC) measurement should be used in some patients at risk for pulmonary hypertension (PH), according to a study published in CHEST.

Researchers extracted clinical data and invasive hemodynamics from 2270 patients undergoing simultaneous right and left heart catheterization at Vanderbilt Hospital from 1984 to2008. The median age of participants was 63 years, 42% were obese, and the reasons for RHC were coronary artery disease (38%), valvular heart disease (18%), and congestive heart failure (16%). The goal was to examine the conflict between pulmonary artery wedge pressure (PAWP) and LVEDP in individuals at risk for PH.

The mean difference between PAWP and LVEDP was –1.6 mm Hg (IQR –15 mm Hg to 12 mm Hg), but both measurements were moderately interconnected by linear regression (R=0.6; P <.0001). In patients with PH (n=1331), results were similar. In older individuals, PAWP underestimation in multivariate models was (odds ratio [OR] 1.77; 95% CI, 1.23-2.45). Atrial fibrillation (OR 1.75; 95% CI, 1.08-2.84), rheumatic valve disease (OR 2.2; 95% CI, 1.36-3.52), and enlarged left atrial diameter (OR 1.70; 95% CI, 1.24-2.32) showed PAWP overestimation of LVEPD.

The researchers concluded that clinicians should consider “the addition of LVEDP measurement to standard RHC measurements in patients at risk of PH.”

Disclosures: Dr Hemnes reported serving as a consultant for Pfizer, United Therapeutics, Bayer, and Actelion. 

Reference

Hemnes AR, Opotowsky AR, Assad TR, et al. Features associated with discordance between pulmonary arterial wedge pressure and left ventricular end diastolic pressure in clinical practice: implications for pulmonary hypertension classification [published online August 24, 2018]. CHEST. doi:10.1016/j.chest.2018.08.1033