The relationship of right- and left-sided filling pressures in patients with heart failure and a preserved ejection fraction

Abstract

Background: Although right-sided filling pressures often mirror left-sided filling pressures in systolic heart failure, it is not known whether a similar relationship exists in heart failure with preserved ejection fraction.

Methods and results: Eleven subjects with heart failure with preserved ejection fraction underwent right heart catheterization at rest and under loading conditions manipulated by lower body negative pressure and saline infusion. Right atrial pressure (RAP) was classified as elevated when >or=10 mm Hg and pulmonary capillary wedge pressure (PCWP) when >or=22 mm Hg. If both the RAP and the PCWP were elevated or both not elevated, they were classified as concordant; otherwise, they were classified as discordant. Correlation of RAP and PCWP was determined by a repeated measures model. Among 66 paired measurements of RAP and PCWP, 44 (67%) had a low RAP and PCWP and 8 (12%) a high RAP and PCWP, yielding a concordance rate of 79%. In a sensitivity analysis performed by varying the definition of elevated RAP (from 8 to 12 mm Hg) and PCWP (from 15 to 25 mm Hg), the mean+/-SD concordance of RAP and PCWP was 76+/-10%. The correlation coefficient of RAP and PCWP for the overall cohort was r=0.86 (P<0.0001).

Conclusions: Right-sided filling pressures often reflect left-sided filling pressures in heart failure with preserved ejection fraction, supporting the role of estimation of jugular venous pressure to assess volume status in this condition.

Figure 1

Classification of 66 paired measurements of RAP and PCWP from the 11 subjects in the study cohort with regard to whether RAP was elevated (≥10 mm Hg) and PCWP was elevated (≥22 mm Hg). Data are presented as number of measurements (%).

Figure 2

Scatterplot of RAP versus PCWP in individual patients (light gray lines) and the overall cohort (blue line) using all loading conditions. The blue line indicates the overall regression equation in the entire cohort, and the red lines are the 95% CIs. The symbols represent data points from individual patients.

Figure 3

Representative hemodynamic pressure waveforms of RAP and PCWP in 2 individual subjects under various loading conditions. A simultaneous ECG is shown at the top. Numbers represent pressure measurements. Note that as the RAP increases, the PCWP increases in concert in both cases. LBNP30 indicates LBNP at −30 mm Hg; LBNP15, LBNP at −15 mm Hg; NS1, a normal saline infusion of ≈10 mL/kg at 100 to 200 mL/min; and NS2, an infusion of ≈20 mL/kg at 100 to 200 mL/min.