Mh. Drazner et al., Relationship between right and left-sided filling pressures in 1000 patients with advanced heart failure, J HEART LUN, 18(11), 1999, pp. 1126-1132
Background: Elevated left ventricular filling pressures present a major tar
get of therapy for symptomatic heart failure but are difficult to assess di
rectly. Because the relationship of left- and right-sided pressures remains
ill defined in chronic heart failure, this study compared 3 right-sided me
asurements (right atrial [RA] pressure, pulmonary artery systolic [PAS] pre
ssure, and severity of tricuspid regurgitation [TR]) to the pulmonary capil
lary wedge (PCW) pressure;
Methods: Hemodynamic measurements and echocardiography were available from
1000 patients undergoing transplant evaluation. Right atrial and PAS pressu
re, and TR severity were compared to PCW pressure, For 754 patients undergo
ing repeat measurements, changes in RA and PAS pressures were compared to P
CW changes.
Results: Right atrial pressure correlated with PCW pressure (r = 0.64), reg
ardless of etiology or TR severity. Right atrial pressure changes correlate
d with PCW changes (r = 0.62). Discordance was defined as either RA greater
than or equal to 10 mm Hg despite PCW < 22 mm Hg (6%) or RA < 10 mm Hg des
pite PCW greater than or equal to 22 mm Hg (15%). For detection of PCW grea
ter than or equal to 22 mm. Hg, positive predictive values were 88% for RA
greater than or equal to 10 mm Hg, 95% for PAS greater than or equal to 60
mm Hg, and 79% for greater than or equal to moderate TR. Pulmonary artery s
ystolic pressure correlated very closely with PCW (r = 0.79), and could be
estimated as 2 x PCW. Reduction in PAS pressure during therapy was strongly
determined by PCW pressure reduction (r = 0.67).
Conclusions: Accurate estimation of RA pressure can potentially guide thera
py of left ventricular filling pressures in approximately 80% of chronic he
art failure patients without: obvious non-cardiac disease. In this populati
on, elevated PAS pressures are largely determined by elevated left-sided fi
lling pressures.