Agreement Between PAWP and LVEDP During Invasive Cardiopulmonary Exercise Testing and Comparison of Prognostic...

Pulmonary artery wedge pressure (PAWP) and left ventricular end-diastolic pressure (LVEDP) are central metrics for assessing filling pressures. A moderate correlation between their resting values has been reported, but their agreement during exercise and associated clinical impact remain unclear. Moreover, their prognostic value is poorly understood. The study's objectives were to: (1) evaluate the correlation between PAWP and LVEDP at rest and during peak exercise; and (2) assess their ability to predict outcomes.

We studied a retrospective cohort of 161 patients undergoing simultaneous resting and exercise PAWP and LVEDP measurements. Associations among filling pressures, physiological variables, and outcomes were evaluated. The primary endpoint was a composite of death, hospitalization due to heart failure, or need for advanced heart failure therapy. The cohort's ages were 68 [53-76] years, and the body mass indexes were 31.7 ± 7.2 kg/m²; 49.1% were female. Resting PAWPs were 16 [11-20] mmHg, and LVEDPs were 19 [15-24] mmHg, increasing to 27 [21-32] mmHg and 28 [23-34] mmHg during exercise, respectively. PAWPs and LVEDPs showed moderate correlation (r = 0.64 rest; r = 0.67 exercise) and poor agreement in detecting elevated filling pressures (Kappa rest 0.32; exercise 0.39). PAWPs correlated better with other hemodynamic parameters than LVEDPs, being associated with the composite outcome when ≥ 20 mmHg at rest (hazard ratio 2.72, 95% confidence interval 1.42-5.19; P = 0.002); this persisted after adjusting for confounders. LVEDPs were not predictive of the outcome.

PAWP was superior to LVEDP in identifying hemodynamic abnormalities and the clinical endpoint, supporting emphasis on PAWP as the primary metric of left heart filling pressures.