Pulmonary capillary wedge pressure showed poor agreement with left ventricular end-diastolic pressure (mean bias -2.87 mmHg), misclassifying pre-capillary pulmonary hypertension in 46.7% of cases.
Observational (n=101)
No
Does PCWP accurately reflect LVEDP for the diagnosis of pre-capillary pulmonary hypertension in a veteran population?
Reliance on PCWP rather than LVEDP results in significant misclassification of pre-capillary pulmonary hypertension versus pulmonary venous hypertension in veterans.
Effect estimate: Mean bias -2.87 mmHg (95% CI -4.316 to -1.42)
BACKGROUND: Accurate determination of left ventricular filling pressure is essential for differentiation of pre-capillary pulmonary hypertension (PH) from pulmonary venous hypertension (PVH). Previous data suggest only a poor correlation between left ventricular end-diastolic pressure (LVEDP) and its commonly used surrogate, the pulmonary capillary wedge pressure (PCWP). However, no data exist on the diagnostic accuracy of PCWP in veterans. Furthermore, the effects of age and comorbidities on the PCWP-LVEDP relationship remain unknown. METHODS: We investigated the PCWP-LVEDP relationship in 101 patients undergoing simultaneous right and left heart catherization at a large VA hospital. PCWP performance was evaluated using correlation and Bland-Altman analyses. Area under Receiver Operating Characteristics curves (AUROC) for PCWP were determined. RESULTS: PCWP-LVEDP correlation was moderate (r = 0.57). PCWP-LVEDP calibration was poor (Bland-Altman limits of agreement -17.2 to 11.4 mmHg; mean bias -2.87 mmHg). 59 patients (58.4%) had pulmonary hypertension; 15 (25.4%) of those met pre-capillary PH criteria based on PCWP. However, if LVEDP was used instead of PCWP, 7/15 patients (46.6%) met criteria for PVH rather than pre-capillary PH. When restricting analysis to patients with a mean pulmonary artery pressure of ≥25 mmHg and pulmonary vascular resistance of >3 Wood units (n = 22), 10 patients (45.4%) were classified as pre-capillary PH based on PCWP ≤15 mmHg. However, if LVEDP was used, 4/10 patients (40%) were reclassified as PVH. Among patients with any type of pulmonary hypertension, PCWP discriminated moderately between high and normal LVEDP (AUROC, 0.81; 95%CI 0.69-0.94). PCWP-LVEDP correlation was particularly poor in patients with COPD or obesity. CONCLUSION: Reliance on PCWP rather than LVEDP results in misclassification of veterans as having pre-capillary PH rather than PVH in almost 50% of cases. This is clinically relevant, as misclassification may lead to inappropriate therapies and adverse events.
Bitar et al. (Fri,) conducted a observational in Pulmonary hypertension (n=101). Pulmonary capillary wedge pressure (PCWP) vs. Left ventricular end-diastolic pressure (LVEDP) was evaluated on Agreement between PCWP and LVEDP (mean bias) (Mean bias -2.87 mmHg, 95% CI -4.316 to -1.42). Pulmonary capillary wedge pressure showed poor agreement with left ventricular end-diastolic pressure (mean bias -2.87 mmHg), misclassifying pre-capillary pulmonary hypertension in 46.7% of cases.