Which Diastolic Pressure Should Be Used to Assess Diastolic Function?
Emre Aslanger1, Özlem Yıldırımtürk2, Dursun Akaslan3
1Department of Cardiology, Health Sciences University, Başakşehir Pine and Sakura City Hospital, İstanbul, Türkiye.
Anatolian Journal of Cardiology
|January 29, 2024
Summary
Transmural pressure difference (∆PTM) better predicts diastolic dysfunction and mortality than pulmonary capillary wedge pressure (PCWP). Using ∆PTM for diastolic function assessment improves clinical decision-making for heart failure patients.
Area of Science:
- Cardiology
- Hemodynamics
- Diastology
Background:
- Left ventricular filling pressures like PCWP are common surrogates for diastolic dysfunction.
- Transmural pressure difference (∆PTM) is the true distending pressure governing LV diastolic stretch.
- Clinical decisions may improve by prioritizing ∆PTM over PCWP.
Purpose of the Study:
- To compare the clinical implications of characterizing diastolic function using PCWP versus ∆PTM.
- To evaluate the predictive power of PCWP- and ∆PTM-based assessments for mortality.
Main Methods:
- Retrospective analysis of adult heart failure patients undergoing right heart catheterization.
- Assessment of LV end-diastolic properties using end-diastolic pressure-volume relationship (EDPVR) curves.
- Survival status determined via electronic health-care system.
Main Results:
- ∆PTM-based EDPVR stiffness constants predicted advanced diastolic dysfunction, unlike PCWP-based constants.
- PCWP-based stiffness constants did not predict 5-year mortality.
- ∆PTM-based EDPVR stiffness constants and volumes significantly predicted 5-year mortality.
Conclusions:
- Left ventricular diastolic function assessment is improved by utilizing ∆PTM instead of PCWP.
- ∆PTM links to right-sided heart functions, highlighting the need for complete hemodynamic assessment.
- This approach emphasizes the non-isolated nature of LV diastolic function in therapeutic and prognostic decisions.
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