Features Associated With Discordance Between Pulmonary Arterial Wedge Pressure and Left Ventricular End Diastolic Pressure in Clinical Practice: Implications for Pulmonary Hypertension Classification

Chest
Anna R HemnesEvan L Brittain

Abstract

The measurements used to define pulmonary hypertension (PH) etiology, pulmonary arterial wedge pressure (PAWP), and left ventricular end-diastolic pressure (LVEDP) vary in clinical practice. We aimed to identify clinical features associated with measurement discrepancy between PAWP and LVEDP in patients with PH. We extracted clinical data and invasive hemodynamics from consecutive patients undergoing concurrent right and left heart catheterization at Vanderbilt University between 1998 and 2014. The primary outcome was discordance between PAWP and LVEDP in patients with PH in a logistic regression model. We identified 2,270 study subjects (median age, 63 years; 53% men). The mean difference between PAWP and LVEDP was -1.6 mm Hg (interquartile range, -15 to 12 mm Hg). The two measurements were moderately correlated by linear regression (R = 0.6, P < .001). Results were similar when restricted to patients with PH. Among patients with PH (n = 1,331), older age (OR, 1.77; 95% CI, 1.23-2.45) was associated with PAWP underestimation in multivariate models, whereas atrial fibrillation (OR, 1.75; 95% CI, 1.08-2.84), a history of rheumatic valve disease (OR, 2.2; 95% CI, 1.36-3.52), and larger left atrial diameter (OR, 1.70; 95% CI, 1.24...Continue Reading

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Citations

Aug 27, 2019·Circulation·Robert Naeije, Kelly Chin
Mar 14, 2019·Current Opinion in Critical Care·Anthony S McLean
May 8, 2020·Cardiac Failure Review·Sriram D RaoJeremy A Mazurek
Dec 21, 2019·European Heart Journal Supplements : Journal of the European Society of Cardiology·Olivier Sitbon, Luke Howard
Sep 3, 2019·Journal of the American Heart Association·Vineet AgrawalEvan L Brittain
Jun 25, 2020·Pulmonary Circulation·Ralf EwertDirk Habedank
Jan 7, 2020·Biomarkers : Biochemical Indicators of Exposure, Response, and Susceptibility to Chemicals·David F MeoliKen Monahan
Aug 18, 2020·Chest·Michele D'AltoRobert Naeije
Jan 19, 2020·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Andriy O SamokhinBradley A Maron

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