Baratto Claudia, Faini Andrea, Gallone Gianluca P, Dewachter Céline, Perego Giovanni B, Bondue Antoine, Muraru Denisa, Senni Michele, Badano Luigi P, Parati Gianfranco, Vachiéry Jean-Luc, Caravita Sergio
Department of Cardiology, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Milan, Italy.
Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.
ERJ Open Res. 2023 Sep 4;9(4). doi: 10.1183/23120541.00750-2022. eCollection 2023 Jul.
Pulmonary artery wedge pressure (PAWP) during exercise, as a surrogate for left ventricular (LV) end-diastolic pressure (EDP), is used to diagnose heart failure with preserved ejection fraction (HFpEF). However, LVEDP is the gold standard to assess LV filling, end-diastolic PAWP (PAWP) is supposed to coincide with LVEDP and mean PAWP throughout the cardiac cycle (PAWP) better reflects the haemodynamic load imposed on the pulmonary circulation. The objective of the present study was to determine precision and accuracy of PAWP estimates for LVEDP during exercise, as well as the rate of agreement between these measures.
46 individuals underwent simultaneous right and left heart catheterisation, at rest and during exercise, to confirm/exclude HFpEF. We evaluated: linear regression between LVEDP and PAWP, Bland-Altman graphs, and the rate of concordance of dichotomised LVEDP and PAWP ≥ or < diagnostic thresholds for HFpEF.
At peak exercise, PAWP and LVEDP, as well as PAWP and LVEDP, were fairly correlated (R>0.69, p<0.01), with minimal bias (+2 and 0 mmHg respectively) but large limits of agreement (±11 mmHg). 89% of individuals had concordant PAWP and LVEDP ≥ or <25 mmHg (Cohen's κ=0.64). Individuals with either LVEDP or PAWP ≥25 mmHg showed a PAWP increase relative to cardiac output (CO) changes (PAWP/CO slope) >2 mmHg·L·min.
During exercise, PAWP is accurate but not precise for the estimation of LVEDP. Despite a good rate of concordance, these two measures might occasionally disagree.
运动期间的肺动脉楔压（PAWP）作为左心室（LV）舒张末期压力（EDP）的替代指标，用于诊断射血分数保留的心力衰竭（HFpEF）。然而，LVEDP是评估左心室充盈的金标准，舒张末期PAWP（PAWP）应与LVEDP一致，而整个心动周期的平均PAWP（PAWP）能更好地反映施加于肺循环的血流动力学负荷。本研究的目的是确定运动期间PAWP估计LVEDP的精密度和准确性，以及这些测量之间的一致性率。
46名个体在静息和运动期间同时进行右心和左心导管插入术，以确诊/排除HFpEF。我们评估了：LVEDP与PAWP之间的线性回归、Bland-Altman图，以及二分法的LVEDP和PAWP≥或<HFpEF诊断阈值的一致性率。
在运动峰值时，PAWP与LVEDP以及PAWP与LVEDP之间具有相当的相关性（R>0.69，p<0.01），偏差最小（分别为+2和0 mmHg），但一致性界限较大（±11 mmHg）。89%的个体PAWP和LVEDP≥或<25 mmHg具有一致性（Cohen's κ=0.64）。LVEDP或PAWP≥25 mmHg的个体显示PAWP相对于心输出量（CO）变化的增加（PAWP/CO斜率）>2 mmHg·L·min。
运动期间，PAWP在估计LVEDP方面准确但不精确。尽管一致性率良好，但这两种测量偶尔可能不一致。
