Wedge Pressure vs Left Ventricular End-Diastolic Pressure for Pulmonary Hypertension Classification and Prognostication in Severe Aortic Stenosis

Maeder, Micha T.; Weber, Lukas; Seidl, Sebastian; Weilenmann, Daniel; Hochholzer, David; Joerg, Lucas; Chronis, Joannis; Rigger, Johannes; Haager, Philipp K.; Rickli, Hans

doi:10.1016/j.cjco.2021.07.004

Cited by 6 publications

(11 citation statements)

References 31 publications

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“…A waiver of consent was granted. We have previously reported on other hemodynamic aspects in this population 9–14 …”

Section: Methodsmentioning

confidence: 89%

ECG left ventricular hypertrophy in aortic stenosis: Relationship with cardiac structure, invasive hemodynamics, and long‐term mortality

Sager,

Rusch,

Weber

et al. 2023

Clinical Cardiology

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BackgroundIn aortic stenosis (AS), left ventricular hypertrophy (LVH) is the response to pressure overload and represents the substrate for a maladaptive cascade, the so‐called AS‐related cardiac damage. We hypothesized that in AS patients electrocardiogram (ECG) LVH not only predicts echocardiography LVH but also other noninvasive and invasive markers of cardiac damage and prognosis after aortic valve replacement (AVR).MethodsIn 279 patients with severe AS undergoing ECG, echocardiography, and cardiac catheterization before AVR, the Sokolow‐Lyon index, the Cornell product, the Romhilt‐Estes score, and the Peguero‐Lo Presti score were assessed.ResultsThe mean left ventricular mass index was 109 ± 34 g/m2, and 131 (47%) patients had echocardiography LVH. The areas under the receiver operator characteristics curve (AUC) for the Sokolow‐Lyon index, the Cornell product, the Romhilt‐Estes score, and the Peguero‐Lo Presti score for the prediction of echocardiography LVH were 0.59, 0.70, 0.63, and 0.65. The Peguero‐Lo Presti score had the numerically greatest AUC for the prediction of left ventricular end‐diastolic pressure >15 mmHg, mean pulmonary artery wedge pressure >15 mmHg, pulmonary vascular resistance >3 Wood units, mean right atrial pressure >14 mmHg, and stroke volume index <31 mL/m2. After a median follow‐up of 1365 (interquartile range: 931–1851) days after AVR only the Peguero‐Lo Presti score was significantly associated with all‐cause mortality [hazard ratio: 1.24 (95% confidence interval: 1.01–1.54); per 1 mV increase; p = .045].ConclusionsAmong severe AS patients, the Peguero‐Lo Presti score is associated with abnormalities in cardiac structure including LVH, invasive measures of cardiac damage, and long‐term mortality after AVR.

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“…A waiver of consent was granted. We have previously reported on other hemodynamic aspects in this population 9–14 …”

Section: Methodsmentioning

confidence: 89%

ECG left ventricular hypertrophy in aortic stenosis: Relationship with cardiac structure, invasive hemodynamics, and long‐term mortality

Sager,

Rusch,

Weber

et al. 2023

Clinical Cardiology

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“…Whether this is also the case in AS patients pre‐ and/or post‐AVR will have to be tested prospectively. Third, we and others have shown that mPAWP and LVEDP can differ substantially 28,29 . This can have impact of the haemodynamic classification of pulmonary hypertension where a few millimetres of mercury can be relevant around the cut‐off value of 15 mmHg 28 .…”

Section: Limitationsmentioning

confidence: 87%

“…Third, we and others have shown that mPAWP and LVEDP can differ substantially. 28 , 29 This can have impact of the haemodynamic classification of pulmonary hypertension where a few millimetres of mercury can be relevant around the cut‐off value of 15 mmHg. 28 Therefore, calculation of LVSWI based on mPAWP is not absolutely accurate.…”

Section: Limitationsmentioning

confidence: 99%

“… 28 , 29 This can have impact of the haemodynamic classification of pulmonary hypertension where a few millimetres of mercury can be relevant around the cut‐off value of 15 mmHg. 28 Therefore, calculation of LVSWI based on mPAWP is not absolutely accurate. However, in this setting the systolic left ventricular pressure is much higher than mPAWP and LVEDP, and the differences between the two are less relevant.…”

Section: Limitationsmentioning

confidence: 99%

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Systemic blood pressure in severe aortic stenosis: Haemodynamic correlates and long‐term prognostic impact

et al. 2022

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Aims Blood pressure (BP) targets in patients with aortic stenosis (AS) are controversial. This study sought to describe the haemodynamic profile and the clinical outcome of severe AS patients with low versus high central meaarterial pressure (MAP). Methods and results Patients with severe AS ( n = 477) underwent right and left heart catheterization prior to aortic valve replacement (AVR). The population was divided into MAP quartiles. The mean systolic BP, diastolic BP, and MAP in the entire population were 149 ± 25, 68 ± 11, and 98 ± 14 mmHg. Patients in the lowest MAP quartile had the lowest left ventricular ejection fraction (LVEF), systemic vascular resistance, and valvulo‐arterial impedance, whereas there were no significant differences in mean right atrial pressure, mean pulmonary artery wedge pressure, pulmonary vascular resistance, and stroke volume index across MAP quartiles. However, left ventricular stroke work index (LVSWI) was lowest in patients in the lowest and highest in those in the highest MAP quartile. After a median (interquartile range) post‐AVR follow‐up of 3.7 (2.6–5.2) years, mortality was highest in patients in the lowest MAP quartile [hazard ratio 3.08 (95% confidence interval 1.21–7.83); P = 0.02 for lowest versus highest quartile]. In the multivariate analysis, lower MAP [hazard ratio 0.78 (95% confidence interval 0.62–0.99) per 10 mmHg increase; P = 0.04], higher mean right atrial pressure and lower LVEF were independent predictors of death. Conclusions In severe AS patients, lower MAP reflects lower systemic vascular resistance and valvulo‐arterial impedance, which may help to preserve stroke volume and filling pressures despite reduced left ventricular performance, and lower MAP is a predictor of higher long‐term post‐AVR mortality.

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“…It has already been shown in a previous study [ 32 ] that patients with atrial fibrillation had higher PCWP than LVEDP values because of the absence of left atrial contraction. Maeder et al [ 33 ] showed in their collective of patients with severe AS and atrial fibrillation a small correlation between PCWP and LVEDP with r = 0.29. This is comparable to our weak regression analysis with an R = 0.216, an R 2 = 0.047 and a p = 0.061.…”

Section: Discussionmentioning

confidence: 99%

Comparison of PCWP and LVEDP Measurements in Patients with Severe Aortic Stenosis Undergoing TAVI—Same Same but Different?

Boxhammer

Mirna

Bäz

et al. 2022

JCM

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Background: Pulmonary capillary wedge pressure (PCWP) and left ventricular end-diastolic pressure (LVEDP) are often used as equivalents for determination of pulmonary hypertension (PH). PH is a comorbidity in patients with severe aortic valve stenosis (AS) and associated with limited prognosis. The aim of the study was to examine the role of differentiated classification basis of PCWP and LVEDP in patients planning for transcatheter aortic valve implantation (TAVI). Methods: 284 patients with severe AS completed a combined left (LHC) and right heart catheterization (RHC) as part of a TAVI planning procedure. Patients were categorized twice into subtypes of PH according to 2015 European Society of Cardiology (ESC) guidelines—on the one hand with PCWP and on the other hand with LVEDP as classification basis. PCWP-LVEDP relationships were figured out using Kaplan-Meier curves, linear regressions and Bland-Altman analysis. Results: Regarding 1-year mortality, Kaplan-Meier analyses showed similar curves in spite of different classification bases of PH subtypes according to PCWP or LVEDP with exception of pre-capillary PH subtype. PCWP-LVEDP association in the overall cohort was barely present (R = 0.210, R2 = 0.044). When focusing analysis on PH patients only a slightly increased linear regression was noted compared to the overall cohort (R = 0.220, R2 = 0.048). The strongest regression was observed in patients with creatinine ≥ 132 µmol/L (R = 0.357, R2 = 0.127) and in patients with mitral regurgitation ≥ II° (R = 0.326, R2 = 0.106). Conclusions: In patients with severe AS, there is a weak association between hemodynamic parameters measured by LHC and RHC. RHC measurements alone are not suitable for risk stratification with respect to one-year mortality. If analysis of hemodynamic parameters is necessary in patients with severe AS scheduled for TAVI, measurement results of LHC and RHC should be combined and LVEDP could serve as a helpful indicator for risk assessment.

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Wedge Pressure vs Left Ventricular End-Diastolic Pressure for Pulmonary Hypertension Classification and Prognostication in Severe Aortic Stenosis

Cited by 6 publications

References 31 publications

ECG left ventricular hypertrophy in aortic stenosis: Relationship with cardiac structure, invasive hemodynamics, and long‐term mortality

ECG left ventricular hypertrophy in aortic stenosis: Relationship with cardiac structure, invasive hemodynamics, and long‐term mortality

Systemic blood pressure in severe aortic stenosis: Haemodynamic correlates and long‐term prognostic impact

Comparison of PCWP and LVEDP Measurements in Patients with Severe Aortic Stenosis Undergoing TAVI—Same Same but Different?

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