TY - JOUR T1 - Pulmonary Artery Wedge Pressure and Left Ventricular End-Diastolic pressure during exercise in patients with dyspnea JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00750-2022 SP - 00750-2022 AU - Claudia Baratto AU - Andrea Faini AU - Gianluca p Gallone AU - Céline Dewachter AU - Giovanni Battista Perego AU - Antoine Bondue AU - Denisa Muraru AU - Michele Senni AU - Luigi p Badano AU - Gianfranco Parati AU - Jean-Luc Vachiéry AU - Sergio Caravita Y1 - 2023/01/01 UR - http://openres.ersjournals.com/content/early/2023/02/02/23120541.00750-2022.abstract N2 - 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.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflicts of interest: none ER -