Author + information
- Received May 10, 2017
- Revision received July 27, 2017
- Accepted August 3, 2017
- Published online October 30, 2017.
- Julia Mascherbauer, MD,
- Caroline Zotter-Tufaro, PhD,
- Franz Duca, MD,
- Christina Binder, MD,
- Matthias Koschutnik,
- Andreas A. Kammerlander, MD,
- Stefan Aschauer, MD and
- Diana Bonderman, MD∗ ()
- ↵∗Address for correspondence:
Dr. Diana Bonderman, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.
Objectives 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).
Background It is broadly accepted that direct measurement of LVEDP in HFpEF more robustly reflects left ventricular hemodynamics than PAWP.
Methods 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.
Results 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.
Conclusions 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.
- diffusing capacity of carbon monoxide
- filling pressures
- heart failure with preserved ejection fraction
Dr. Mascherbauer has received support from the Austrian Society of Cardiology, the Österreichischer Herzfonds, and Austrian fellowship grant KLI 245. Dr. Bonderman has received support from Austrian fellowship grant KLI 246. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 10, 2017.
- Revision received July 27, 2017.
- Accepted August 3, 2017.
- 2017 American College of Cardiology Foundation