Anikó I Nagy1, Ashwin Venkateshvaran2, Pravat Kumar Dash3, Banajit Barooah3, Béla Merkely1, Reidar Winter4, Aristomenis Manouras4. 1. Heart and Vascular Centre, Semmelweis University, Budapest, Hungary. 2. School for Technology and Health, Royal Institute of Technology, Stockholm, Sweden; Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India. 3. Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India. 4. School for Technology and Health, Royal Institute of Technology, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
Abstract
BACKGROUND: Pulmonary capillary wedge pressure (PCWP) is routinely used as an indirect measure of the left atrial pressure (LAP), although the accuracy of this estimate, especially under pathological hemodynamic conditions, remains controversial. OBJECTIVES: The aim of this prospective study was to investigate the reliability of PCWP for the evaluation of LAP under different hemodynamic conditions. METHODS: Simultaneous left and right heart catheterization data of 117 patients with pure mitral stenosis, obtained before and immediately after percutaneous mitral comissurotomy, were analyzed. RESULTS: A strong correlation and agreement between PCWP and LAP measurements was demonstrated (correlation coefficient = 0.97, mean bias ± CI, 0.3 ± -3.7 to 4.2 mm Hg). Comparison of measurements performed within a 5-minute interval and those performed simultaneously revealed that simultaneous pressure acquisition yielded better agreement between the 2 methods (bias ± CI, 1.82 ± 1.98 mm Hg). In contrast to previous observations, the discrepancy between the 2 measures did not increase with elevated PCWP. Multiple regression analysis failed to identify hemodynamic confounders of the discrepancy between the 2 pressures. The ability of PCWP to distinguish between normal and elevated LAP (cutoff set at 12 and 15 mm Hg, respectively), as tested by receiver operating characteristics analysis, demonstrated a remarkably high diagnostic accuracy (area under the curve: 0.989 and 0.996, respectively). CONCLUSIONS: Although the described limits of agreement may not allow the interchangeability of PCWP and LAP, especially at lower pressure ranges, our data support the clinical use of PCWP as a robust and accurate estimate of LAP.
BACKGROUND: Pulmonary capillary wedge pressure (PCWP) is routinely used as an indirect measure of the left atrial pressure (LAP), although the accuracy of this estimate, especially under pathological hemodynamic conditions, remains controversial. OBJECTIVES: The aim of this prospective study was to investigate the reliability of PCWP for the evaluation of LAP under different hemodynamic conditions. METHODS: Simultaneous left and right heart catheterization data of 117 patients with pure mitral stenosis, obtained before and immediately after percutaneous mitral comissurotomy, were analyzed. RESULTS: A strong correlation and agreement between PCWP and LAP measurements was demonstrated (correlation coefficient = 0.97, mean bias ± CI, 0.3 ± -3.7 to 4.2 mm Hg). Comparison of measurements performed within a 5-minute interval and those performed simultaneously revealed that simultaneous pressure acquisition yielded better agreement between the 2 methods (bias ± CI, 1.82 ± 1.98 mm Hg). In contrast to previous observations, the discrepancy between the 2 measures did not increase with elevated PCWP. Multiple regression analysis failed to identify hemodynamic confounders of the discrepancy between the 2 pressures. The ability of PCWP to distinguish between normal and elevated LAP (cutoff set at 12 and 15 mm Hg, respectively), as tested by receiver operating characteristics analysis, demonstrated a remarkably high diagnostic accuracy (area under the curve: 0.989 and 0.996, respectively). CONCLUSIONS: Although the described limits of agreement may not allow the interchangeability of PCWP and LAP, especially at lower pressure ranges, our data support the clinical use of PCWP as a robust and accurate estimate of LAP.
Authors: Desabandhu Vinayakumar; Uppalakal Bijilesh; C G Sajeev; Gopalan Nair Rajesh; Cicy Bastion; P Kadermuneer; V Haridasan; Dolly Mathew; Biju George; M N Krishnan Journal: Indian Heart J Date: 2016-01-18
Authors: Leor Perl; Elina Soifer; Jozef Bartunek; Dedi Erdheim; Friedrich Köhler; William T Abraham; David Meerkin Journal: J Cardiovasc Transl Res Date: 2019-01-02 Impact factor: 4.132
Authors: Susanna Price; Elke Platz; Louise Cullen; Guido Tavazzi; Michael Christ; Martin R Cowie; Alan S Maisel; Josep Masip; Oscar Miro; John J McMurray; W Frank Peacock; F Javier Martin-Sanchez; Salvatore Di Somma; Hector Bueno; Uwe Zeymer; Christian Mueller Journal: Nat Rev Cardiol Date: 2017-04-27 Impact factor: 32.419