Improved Interpretation of Pulmonary Artery Wedge Pressures through Left Atrial Volumetry-A Cardiac Magnetic Resonance Imaging Study.
Gülmisal Güder, Theresa Reiter, Maria Drayss, Wolfgang Bauer, Björn Lengenfelder, Peter Nordbeck, Georg Fette, Stefan Frantz, Caroline Morbach, Stefan Störk
Author Information
Gülmisal Güder: Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany. ORCID
Theresa Reiter: Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany. ORCID
Maria Drayss: Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany. ORCID
Wolfgang Bauer: Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany. ORCID
Björn Lengenfelder: Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany.
Peter Nordbeck: Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany. ORCID
Georg Fette: Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, 97078 Würzburg, Germany. ORCID
Stefan Frantz: Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany. ORCID
Caroline Morbach: Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany. ORCID
Stefan Störk: Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany. ORCID
BACKGROUND: The pulmonary artery wedge pressure (PAWP) is regarded as a reliable indicator of left ventricular end-diastolic pressure (LVEDP), but this association is weaker in patients with left-sided heart disease (LHD). We compared morphological differences in cardiac magnetic resonance imaging (CMR) in patients with heart failure (HF) and a reduced left ventricular ejection fraction (LVEF), with or without elevation of PAWP or LVEDP. METHODS: We retrospectively identified 121 patients with LVEF < 50% who had undergone right heart catheterization (RHC) and CMR. LVEDP data were available for 75 patients. RESULTS: The mean age of the study sample was 63 ± 14 years, the mean LVEF was 32 ± 10%, and 72% were men. About 53% of the patients had an elevated PAWP (>15 mmHg). In multivariable logistic regression analysis, NT-proBNP, left atrial ejection fraction (LAEF), and LV end-systolic volume index independently predicted an elevated PAWP. Of the 75 patients with available LVEDP data, 79% had an elevated LVEDP, and 70% had concomitant PAWP elevation. By contrast, all but one patient with elevated PAWP and half of the patients with normal PAWP had concomitant LVEDP elevation. The Bland-Altman plot revealed a systematic bias of +5.0 mmHg between LVEDP and PAWP. Notably, LAEF was the only CMR variable that differed significantly between patients with elevated LVEDP and a PAWP ≤ or >15 mmHg. CONCLUSIONS: In patients with LVEF < 50%, a normal PAWP did not reliably exclude LHD, and an elevated LVEDP was more frequent than an elevated PAWP. LAEF was the most relevant determinant of an increased PAWP, suggesting that a preserved LAEF in LHD may protect against backward failure into the lungs and the subsequent increase in pulmonary pressure.
