Why the study?
The diagnostic utility of the diastolic pressure gradient in left heart failure is compromised by frequent negative values and contradictory prognostic evidence, likely influenced by pressure pulsatility.
Does calculating the diastolic pressure gradient using the instantaneous PAWP at the trough of the Y-descent improve prognostic assessment compared to conventional DPG in heart failure patients?
Does calculating the diastolic pressure gradient using the instantaneous PAWP at the trough of the Y-descent improve prognostic assessment compared to conventional DPG in heart failure patients?
Calculating the diastolic pressure gradient using the instantaneous pulmonary artery wedge pressure at the trough of the Y-descent reduces physiologically incompatible negative values and provides independent prognostic value in heart failure patients.
Aims The diastolic pressure gradient (DPG) has been proposed as a marker pulmonary vascular disease in the setting of left heart failure (HF). However, its diagnostic utility is compromised by the high prevalence of physiologically incompatible negative values (DPG NEG ) and the contradictory evidence on its prognostic value. Pressure pulsatility impacts on DPG measurements, thus conceivably, pulmonary artery wedge pressure (PAWP) measurements insusceptible to the oscillatory effect of the V-wave might yield a more reliable DPG assessment. We set out to investigate how the instantaneous PAWP at the trough of the Y -descent (PAWP Y ) influences the prevalence of DPG NEG and the prognostic value of the resultant DPG Y . Methods Hundred and fifty-three consecutive HF patients referred for right heart catheterisation were enrolled prospectively. DPG, as currently recommended, was calculated. Subsequently, PAWP Y was measured and the corresponding DPG Y was calculated. Results DPG Y yielded higher values (median, IQR: 3.2, 0.6–5.7 mmHg) than DPG (median, IQR: 0.9, − 1.7–3.8 mmHg); p < 0.001. Conventional DPG was negative in 45% of the patients whereas DPG Y in only 15%. During follow-up (22 ± 14 months) 58 patients have undergone heart-transplantation or died. The predictive ability of DPG Y ≥ 6 mmHg for the above defined end-point events was significant [HR 2.1; p = 0.007] and independent of resting mean pulmonary artery pressure (PAP M ). In contrast, conventional DPG did not comprise significant prognostic value following adjustment for PAP M . Conclusion Instantaneous pressures at the trough of Y -descent yield significantly fewer DPG NEG than conventional DPG and entail superior prognostic value in HF patients with and without PH. Graphic abstract
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Manouras et al. (2020) studied this question.
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