Charalampopoulos, A

Gibbs, S

Howard, L

Simonsen, U

Su, J

European Heart Journal

Spiral - Imperial College Digital Repository

Impact of atrial contraction on diagnosis of pre- vs post-capillary pulmonary hypertension   Junjing Su1,2, Athanasios Charalampopoulos3, Ulf Simonsen1, Simon Gibbs2 and Luke Howard2  1. Department of Biomedicine – Pharmacology, Aarhus University 2. National Heart and Lung Institute, Imperial College London 3. Pulmonary Vascular Unit, Royal Hallamshire Hospital, Sheffield  Background: Establishing post-capillary hemodynamics in pulmonary hypertension (PH) is documented by measuring an elevated pulmonary capillary wedge pressure (PCWP > 15 mmHg). However, the accuracy of PCWP to reflect left ventricular (LV) diastolic pressures in the PH population is under debate. The aim of the study is to investigate the agreement between PCWP and LV diastolic pressures in PH patients with and without atrial fibrillation.   Method: Original pressure traces of 128 PH patients were reviewed. Mean PCWP was taken at end-expiration. LV diastolic pressure before atrial contraction (pre-A LVDP) was measured at the onset of the LV A-wave and LV end-diastolic pressure (LVEDP) was measured at the nadir of A-wave or at the peak of R-wave on ECG.  Results: In the 99 patients in sinus rhythm (62  15 yrs, 53 % male), pre-A LVDP, LVEDP and PCWP were 12  5 mmHg, 17  7 mmHg and 17  6 mmHg, respectively. The sensitivity, specificity, positive and negative predictive values of PCWP to reflect abnormal LVEDP were each 90 %. The agreement between LVEDP and PCWP was best in patients with normal LVEDP (mean difference 0.4  2.7 mmHg), while PCWP underestimated LVEDP by 2.6  4.7 mmHg in a subgroup of patients with elevated LVEDP combined with large a LV A-wave (> 5 mmHg). In the 29 patients with atrial fibrillation (72 ± 8 yrs, 52 % male), PCWP consistently overestimated LVEDP due to the lack of LV A-wave with a mean difference of 4.8 ± 3.1 mmHg. The sensitivity, specificity, positive and negative predictive values of PCWP to reflect abnormal LVEDP were 100 %, 8 %, 61 % and 100 %, respectively.  Conclusion: PCWP reliably reflects pre- and post-capillary PH during sinus rhythm. There is poor agreement between PCWP and LVEDP in PH patients with atrial fibrillation which may lead to issues with patient classification.       

Impact of atrial contraction on diagnosis of pre- versus post-capillary pulmonary hypertension

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