Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, the Netherlands (A.A.v.d.B., N.W., A.C.v.R., M.L.H.).
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pulmonology, Amsterdam Cardiovascular Sciences, the Netherlands (F.P.T.O., A.V.N., H.J.B., F.S.d.M.).
Circ Heart Fail. 2022 Apr;15(4):e008935. doi: 10.1161/CIRCHEARTFAILURE.121.008935. Epub 2022 Mar 21.
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.
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 PCWP was compared with the gold standard (PCWP). Cut-offs derived from our cohort were subsequently validated in an external cohort (N=74).
Thirty-nine non-HFpEF, 33 occult-HFpEF, and 37 manifest-HFpEF patients were included (N=109). In patients with normal PCWP (<15 mmHg), PCWP significantly improved diagnostic accuracy compared with PCWP (AUC=0.82 versus 0.69, =0.03). PCWP ≥19 mmHg (24% of cases) had a specificity of 100% for diagnosing occult-HFpEF, irrespective of diuretic use. PCWP ≥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 PCWP or V-wave derived parameters had no incremental value in diagnosing occult-HFpEF.
PCWP is a simple and powerful tool that can help to diagnose or rule out occult-HFpEF.
由于无创检查的准确性有限，舒张性应激试验在射血分数保留的心力衰竭（HFpEF）患者的诊断中发挥着重要作用。运动右心导管检查被认为是金标准，当怀疑 HFpEF 但静息左心室充盈压正常时则需要进行该检查。然而，并非在所有地方都可以进行运动右心导管检查。在这里，我们研究了被动抬腿（PLR）期间肺毛细血管楔压（PCWP）是否可作为一种简单而准确的方法来诊断或排除隐匿性 HFpEF。
在我们的肺动脉高压和 HFpEF 三级中心，所有接受诊断性右心导管检查并测量静息、PLR 和运动时 PCWP 的患者都进行了评估（2014-2020 年）。将 PCWP 的诊断价值与金标准（PCWP）进行了比较。从我们的队列中得出的截止值随后在外部队列（N=74）中进行了验证。
纳入了 39 例非 HFpEF、33 例隐匿性 HFpEF 和 37 例显性 HFpEF 患者（N=109）。在 PCWP<15mmHg 的患者中，PCWP 与 PCWP 相比显著提高了诊断准确性（AUC=0.82 与 0.69，=0.03）。PCWP≥19mmHg（占病例的 24%）诊断隐匿性 HFpEF 的特异性为 100%，无论是否使用利尿剂。PCWP≥11mmHg 诊断隐匿性 HFpEF 的敏感性和阴性预测值均为 100%。这两个截止值在外部队列中均具有 100%的特异性和 100%的敏感性。PCWP 或 V 波衍生参数的绝对变化对诊断隐匿性 HFpEF 没有增量价值。
PCWP 是一种简单而强大的工具，可帮助诊断或排除隐匿性 HFpEF。
