Abstract
Background Pulmonary Artery Wedge Pressure (PAWP) during exercise, as a surrogate for Left Ventricular (LV) End-Diastolic Pressure (EDP), is used to diagnose heart failure with preserved ejection fraction (HFpEF). However, LVEDP is the gold-standard to assess LV filling, end-diastolic PAWP (PAWPED) is supposed to coincide with LVEDP, and mean PAWP throughout the cardiac cycle (PAWPM) better reflects the hemodynamic load imposed on the pulmonary circulation.
Objective To determine precision and accuracy of PAWP estimates for LVEDP during exercise, as well as the rate of agreement between these measures.
Methods Forty-six individuals underwent simultaneous right and left heart catheterization, at rest and during exercise, to confirm/exclude HFpEF. We evaluated: linear regression between LVEDP and PAWP, Bland-Altman graphs, and the rate of concordance of dichotomized LVEDP and PAWP≥or<diagnostic thresholds for HFpEF.
Results At peak exercise, PAWPM and LVEDP, as well as PAWPED and LVEDP, were fairly correlated (R2>0.69, p<0.01), with minimal bias (+2 and 0 mmHg respectively) but large limits of agreement (±11 mmHg). Eighty-nine percent of individuals had concordant PAWP and LVEDP≥or <25 mmHg (Cohen's kappa=0.64). Individuals with either LVEDP or PAWPM ≥25 mmHg showed a PAWPM increase relative to cardiac output changes (PAWPM/CO slope)>2 mmHg L−1·min−1.
Conclusions During exercise, PAWP is accurate but not precise for the estimation of LVEDP. Despite a good rate of concordance, these two measures might occasionally disagree.
Footnotes
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- Received December 27, 2022.
- Accepted January 28, 2023.
- Copyright ©The authors 2023
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