Comparison of PCWP and LVEDP Measurements in Patients with Severe Aortic Stenosis Undergoing TAVI—Same Same but Different?
Background: Pulmonary capillary wedge pressure (PCWP) and left ventricular end-diastolic pressure (LVEDP) are often used as equivalents for determination of pulmonary hypertension (PH). PH is a comorbidity in patients with severe aortic valve stenosis (AS) and associated with limited prognosis. The...
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| Format: | Article |
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MDPI AG
2022-05-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/11/2978 |
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| author | Elke Boxhammer Moritz Mirna Laura Bäz Brunilda Alushi Marcus Franz Daniel Kretzschmar Uta C. Hoppe Alexander Lauten Michael Lichtenauer |
| author_facet | Elke Boxhammer Moritz Mirna Laura Bäz Brunilda Alushi Marcus Franz Daniel Kretzschmar Uta C. Hoppe Alexander Lauten Michael Lichtenauer |
| author_sort | Elke Boxhammer |
| collection | DOAJ |
| description | Background: Pulmonary capillary wedge pressure (PCWP) and left ventricular end-diastolic pressure (LVEDP) are often used as equivalents for determination of pulmonary hypertension (PH). PH is a comorbidity in patients with severe aortic valve stenosis (AS) and associated with limited prognosis. The aim of the study was to examine the role of differentiated classification basis of PCWP and LVEDP in patients planning for transcatheter aortic valve implantation (TAVI). Methods: 284 patients with severe AS completed a combined left (LHC) and right heart catheterization (RHC) as part of a TAVI planning procedure. Patients were categorized twice into subtypes of PH according to 2015 European Society of Cardiology (ESC) guidelines—on the one hand with PCWP and on the other hand with LVEDP as classification basis. PCWP-LVEDP relationships were figured out using Kaplan-Meier curves, linear regressions and Bland-Altman analysis. Results: Regarding 1-year mortality, Kaplan-Meier analyses showed similar curves in spite of different classification bases of PH subtypes according to PCWP or LVEDP with exception of pre-capillary PH subtype. PCWP-LVEDP association in the overall cohort was barely present (R = 0.210, R<sup>2</sup> = 0.044). When focusing analysis on PH patients only a slightly increased linear regression was noted compared to the overall cohort (R = 0.220, R<sup>2</sup> = 0.048). The strongest regression was observed in patients with creatinine ≥ 132 µmol/L (R = 0.357, R<sup>2</sup> = 0.127) and in patients with mitral regurgitation ≥ II° (R = 0.326, R<sup>2</sup> = 0.106). Conclusions: In patients with severe AS, there is a weak association between hemodynamic parameters measured by LHC and RHC. RHC measurements alone are not suitable for risk stratification with respect to one-year mortality. If analysis of hemodynamic parameters is necessary in patients with severe AS scheduled for TAVI, measurement results of LHC and RHC should be combined and LVEDP could serve as a helpful indicator for risk assessment. |
| first_indexed | 2024-03-10T01:13:26Z |
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| id | doaj.art-b6590ef0683d441da8049287f6500c98 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T01:13:26Z |
| publishDate | 2022-05-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-b6590ef0683d441da8049287f6500c982023-11-23T14:14:42ZengMDPI AGJournal of Clinical Medicine2077-03832022-05-011111297810.3390/jcm11112978Comparison of PCWP and LVEDP Measurements in Patients with Severe Aortic Stenosis Undergoing TAVI—Same Same but Different?Elke Boxhammer0Moritz Mirna1Laura Bäz2Brunilda Alushi3Marcus Franz4Daniel Kretzschmar5Uta C. Hoppe6Alexander Lauten7Michael Lichtenauer8Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, AustriaDepartment of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, AustriaUniversitäts-Herzzentrum Thüringen, Clinic of Internal Medicine I, Department of Cardiology, Friedrich Schiller University, 07743 Jena, GermanyDepartment of General and Interventional Cardiology and Rhythmology, Helios Hospital Erfurt, 99089 Erfurt, GermanyUniversitäts-Herzzentrum Thüringen, Clinic of Internal Medicine I, Department of Cardiology, Friedrich Schiller University, 07743 Jena, GermanyUniversitäts-Herzzentrum Thüringen, Clinic of Internal Medicine I, Department of Cardiology, Friedrich Schiller University, 07743 Jena, GermanyDepartment of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, AustriaDepartment of General and Interventional Cardiology and Rhythmology, Helios Hospital Erfurt, 99089 Erfurt, GermanyDepartment of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, AustriaBackground: Pulmonary capillary wedge pressure (PCWP) and left ventricular end-diastolic pressure (LVEDP) are often used as equivalents for determination of pulmonary hypertension (PH). PH is a comorbidity in patients with severe aortic valve stenosis (AS) and associated with limited prognosis. The aim of the study was to examine the role of differentiated classification basis of PCWP and LVEDP in patients planning for transcatheter aortic valve implantation (TAVI). Methods: 284 patients with severe AS completed a combined left (LHC) and right heart catheterization (RHC) as part of a TAVI planning procedure. Patients were categorized twice into subtypes of PH according to 2015 European Society of Cardiology (ESC) guidelines—on the one hand with PCWP and on the other hand with LVEDP as classification basis. PCWP-LVEDP relationships were figured out using Kaplan-Meier curves, linear regressions and Bland-Altman analysis. Results: Regarding 1-year mortality, Kaplan-Meier analyses showed similar curves in spite of different classification bases of PH subtypes according to PCWP or LVEDP with exception of pre-capillary PH subtype. PCWP-LVEDP association in the overall cohort was barely present (R = 0.210, R<sup>2</sup> = 0.044). When focusing analysis on PH patients only a slightly increased linear regression was noted compared to the overall cohort (R = 0.220, R<sup>2</sup> = 0.048). The strongest regression was observed in patients with creatinine ≥ 132 µmol/L (R = 0.357, R<sup>2</sup> = 0.127) and in patients with mitral regurgitation ≥ II° (R = 0.326, R<sup>2</sup> = 0.106). Conclusions: In patients with severe AS, there is a weak association between hemodynamic parameters measured by LHC and RHC. RHC measurements alone are not suitable for risk stratification with respect to one-year mortality. If analysis of hemodynamic parameters is necessary in patients with severe AS scheduled for TAVI, measurement results of LHC and RHC should be combined and LVEDP could serve as a helpful indicator for risk assessment.https://www.mdpi.com/2077-0383/11/11/2978aortic valve stenosisleft ventricular end-diastolic pressurepulmonary capillary wedge pressureright heart catheterTAVI |
| spellingShingle | Elke Boxhammer Moritz Mirna Laura Bäz Brunilda Alushi Marcus Franz Daniel Kretzschmar Uta C. Hoppe Alexander Lauten Michael Lichtenauer Comparison of PCWP and LVEDP Measurements in Patients with Severe Aortic Stenosis Undergoing TAVI—Same Same but Different? Journal of Clinical Medicine aortic valve stenosis left ventricular end-diastolic pressure pulmonary capillary wedge pressure right heart catheter TAVI |
| title | Comparison of PCWP and LVEDP Measurements in Patients with Severe Aortic Stenosis Undergoing TAVI—Same Same but Different? |
| title_full | Comparison of PCWP and LVEDP Measurements in Patients with Severe Aortic Stenosis Undergoing TAVI—Same Same but Different? |
| title_fullStr | Comparison of PCWP and LVEDP Measurements in Patients with Severe Aortic Stenosis Undergoing TAVI—Same Same but Different? |
| title_full_unstemmed | Comparison of PCWP and LVEDP Measurements in Patients with Severe Aortic Stenosis Undergoing TAVI—Same Same but Different? |
| title_short | Comparison of PCWP and LVEDP Measurements in Patients with Severe Aortic Stenosis Undergoing TAVI—Same Same but Different? |
| title_sort | comparison of pcwp and lvedp measurements in patients with severe aortic stenosis undergoing tavi same same but different |
| topic | aortic valve stenosis left ventricular end-diastolic pressure pulmonary capillary wedge pressure right heart catheter TAVI |
| url | https://www.mdpi.com/2077-0383/11/11/2978 |
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