The Value of Passive Leg Raise During Right Heart Catheterization in Diagnosing Heart Failure With Preserved Ejection Fraction

Central haemodynamic abnormalities and outcome in patients with unexplained dyspnoea

“…Risk of the composite outcome was compared among three patient groups defined a priori : (1) NCD (normal rest and exercise haemodynamics, defined above), (2) HFpEF with normal resting PAWP (<15 mmHg), but abnormal exercise PAWP (≥25 mmHg), and (3) HFpEF defined by abnormal resting PAWP (≥15 mmHg). Risk was also compared in HFpEF based upon externally‐validated diagnostic cutpoints, including leg raise PAWP ≥19 or <19 mmHg, 21 and by grouping patients with HFpEF by PAWP during exercise above and below the median. Similar comparisons were made using other haemodynamic measures in HFpEF above and below the group median values for other haemodynamic and oxygen transport measures, as compared to NCD.…”

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

“…There are insufficient data on the haemodynamic response to fluid challenge in patients with PAH. Recent data suggest that passive leg raise during RHC may also help to uncover occult HFpEF [144].…”

Update in approaches to pulmonary hypertension because of left heart disease

“…The accuracy of the PCWP measurement can be confirmed either by measurement of the PCWP blood oxygen saturation (normal is 90% or greater) or direct measurement of left ventricular end diastolic pressure. In patients with normal resting PCWP but high suspicion for PH-LHD, provocative maneuvers, such as fluid challenge, passive leg, or exercise during right heart catheterization can clarify the diagnosis [4 ▪▪ ]. Features suggestive of PH-LHD include older age, obesity, left atrial dilation, left ventricular hypertrophy, systemic hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation, prior cardiac interventions, and prominent V wave on PCWP waveform [5].…”

“…confirmed either by measurement of the PCWP blood oxygen saturation (normal is 90% or greater) or direct measurement of left ventricular end diastolic pressure. In patients with normal resting PCWP but high suspicion for PH-LHD, provocative maneuvers, such as fluid challenge, passive leg, or exercise during right heart catheterization can clarify the diagnosis[4 …”