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. 2022 Apr;15(4):e008935.
doi: 10.1161/CIRCHEARTFAILURE.121.008935. Epub 2022 Mar 21.

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

Arno A van de Bovenkamp  1 , Niels Wijkstra  1 , Frank P T Oosterveer  2 , Anton Vonk Noordegraaf  2 , Harm Jan Bogaard  2 , Albert C van Rossum  1 , Frances S de Man  2 , Barry A Borlaug  3 , M Louis Handoko  1
Affiliations

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

Arno A van de Bovenkamp et al. Circ Heart Fail. 2022 Apr.

Abstract

Background: Because of limited accuracy of noninvasive tests, diastolic stress testing plays an important role in the diagnostic work-up of patients with heart failure with preserved ejection fraction (HFpEF). Exercise right heart catheterization is considered the gold standard and indicated when HFpEF is suspected but left ventricular filling pressures at rest are normal. However, performing exercise during right heart catheterization is not universally available. Here, we examined whether pulmonary capillary wedge pressure (PCWP) during a passive leg raise (PLR) could be used as simple and accurate method to diagnose or rule out occult-HFpEF.

Methods: In our tertiary center for pulmonary hypertension and HFpEF, all patients who received a diagnostic right heart catheterization with PCWP-measurements at rest, PLR, and exercise were evaluated (2014-2020). The diagnostic value of PCWPPLR was compared with the gold standard (PCWPEXERCISE). Cut-offs derived from our cohort were subsequently validated in an external cohort (N=74).

Results: Thirty-nine non-HFpEF, 33 occult-HFpEF, and 37 manifest-HFpEF patients were included (N=109). In patients with normal PCWPREST (<15 mmHg), PCWPPLR significantly improved diagnostic accuracy compared with PCWPREST (AUC=0.82 versus 0.69, P=0.03). PCWPPLR ≥19 mmHg (24% of cases) had a specificity of 100% for diagnosing occult-HFpEF, irrespective of diuretic use. PCWPPLR ≥11 mmHg had a 100% sensitivity and negative predictive value for diagnosing occult-HFpEF. Both cut-offs retained a 100% specificity and 100% sensitivity in the external cohort. Absolute change in PCWPPLR or V-wave derived parameters had no incremental value in diagnosing occult-HFpEF.

Conclusions: PCWPPLR is a simple and powerful tool that can help to diagnose or rule out occult-HFpEF.

Keywords: diuretic; heart failure; hypertension, pulmonary; leg; pulmonary wedge pressure.

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Figures

Figure 1.
Figure 1.
Pulmonary capillary wedge pressure (PCWP) at rest, passive leg raise (PLR), and exercise. Dots (●) are the individual data points. Triangles (▲) are the mean value of the group. HFpEF indicates heart failure with preserved ejection fraction.
Figure 2.
Figure 2.
Receiver operating characteristics curve analysis to diagnose occult-heart failure with preserved ejection fraction (HFpEF; manifest-HFpEF excluded). AUC indicates area under the curve; PCWP, pulmonary capillary wedge pressure; and PLR, passive leg raise.
Figure 3.
Figure 3.
Receiver operating characteristics curve analysis to diagnose occult heart failure with preserved ejection fraction (derivation-cohort and external validation). AUC indicates area under the curve; PCWP, pulmonary capillary wedge pressure; and PLR, passive leg raise.
Figure 4.
Figure 4.
Implementation of passive leg raise test during right heart catheterization. HFpEF indicates heart failure with preserved ejection fraction; PCWP, pulmonary capillary wedge pressure; and PLR, passive leg raise.
See this image and copyright information in PMC

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