Relationship between right and left-sided filling pressures in 1000 patients with advanced heart failure

Mark H. Drazner, Michele A. Hamilton, Gregg Fonarow, Julie Creaser, Carol Flavell, Lynne Warner Stevenson

Research output: Contribution to journalArticle

150 Citations (Scopus)

Abstract

Background: Elevated left ventricular filling pressures present a major target of therapy for symptomatic heart failure but are difficult to assess directly. Because the relationship of left- and right-sided pressures remains ill defined in chronic heart failure, this study compared 3 right-sided measurements (right atrial [RA] pressure, pulmonary artery systolic [PAS] pressure, and severity of tricuspid regurgitation [TR]) to the pulmonary capillary wedge (PCW) pressure. Methods: Hemodynamic measurements and echocardiography were available from 1000 patients undergoing transplant evaluation. Right atrial and PAS pressure, and TR severity were compared to PCW pressure. For 754 patients undergoing repeat measurements, changes in RA and PAS pressures were compared to PCW changes.Results: Right atrial pressure correlated with PCW pressure (r = 0.64), regardless of etiology or TR severity. Right atrial pressure changes correlated with PCW changes (r = 0.62). Discordance was defined as either RA ≥ 10 mm Hg despite PCW < 22 mm Hg (6%) or RA < 10 mm Hg despite PCW ≥ 22 mm Hg (15%). For detection of PCW ≥ 22 mm Hg, positive predictive values were 88% for RA ≥ 10 mm Hg, 95% for PAS ≥ 60 mm Hg, and 79% for ≥ moderate TR. Pulmonary artery systolic 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 therapy of left ventricular filling pressures in approximately 80% of chronic heart failure patients without obvious non-cardiac disease. In this population, elevated PAS pressures are largely determined by elevated left-sided filling pressures. Copyright (C) 1999 International Society for Heart and Lung Transplantation.

Original languageEnglish (US)
Pages (from-to)1126-1132
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume18
Issue number11
DOIs
StatePublished - Nov 1999

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Pulmonary Artery
Heart Failure
Tricuspid Valve Insufficiency
Pulmonary Wedge Pressure
Atrial Pressure
Pressure
Lung
Blood Pressure
Ventricular Pressure
Echocardiography
Therapeutics
Hemodynamics
Transplants
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

Relationship between right and left-sided filling pressures in 1000 patients with advanced heart failure. / Drazner, Mark H.; Hamilton, Michele A.; Fonarow, Gregg; Creaser, Julie; Flavell, Carol; Warner Stevenson, Lynne.

In: Journal of Heart and Lung Transplantation, Vol. 18, No. 11, 11.1999, p. 1126-1132.

Research output: Contribution to journalArticle

Drazner, Mark H. ; Hamilton, Michele A. ; Fonarow, Gregg ; Creaser, Julie ; Flavell, Carol ; Warner Stevenson, Lynne. / Relationship between right and left-sided filling pressures in 1000 patients with advanced heart failure. In: Journal of Heart and Lung Transplantation. 1999 ; Vol. 18, No. 11. pp. 1126-1132.
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abstract = "Background: Elevated left ventricular filling pressures present a major target of therapy for symptomatic heart failure but are difficult to assess directly. Because the relationship of left- and right-sided pressures remains ill defined in chronic heart failure, this study compared 3 right-sided measurements (right atrial [RA] pressure, pulmonary artery systolic [PAS] pressure, and severity of tricuspid regurgitation [TR]) to the pulmonary capillary wedge (PCW) pressure. Methods: Hemodynamic measurements and echocardiography were available from 1000 patients undergoing transplant evaluation. Right atrial and PAS pressure, and TR severity were compared to PCW pressure. For 754 patients undergoing repeat measurements, changes in RA and PAS pressures were compared to PCW changes.Results: Right atrial pressure correlated with PCW pressure (r = 0.64), regardless of etiology or TR severity. Right atrial pressure changes correlated with PCW changes (r = 0.62). Discordance was defined as either RA ≥ 10 mm Hg despite PCW < 22 mm Hg (6{\%}) or RA < 10 mm Hg despite PCW ≥ 22 mm Hg (15{\%}). For detection of PCW ≥ 22 mm Hg, positive predictive values were 88{\%} for RA ≥ 10 mm Hg, 95{\%} for PAS ≥ 60 mm Hg, and 79{\%} for ≥ moderate TR. Pulmonary artery systolic 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 therapy of left ventricular filling pressures in approximately 80{\%} of chronic heart failure patients without obvious non-cardiac disease. In this population, elevated PAS pressures are largely determined by elevated left-sided filling pressures. Copyright (C) 1999 International Society for Heart and Lung Transplantation.",
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AU - Warner Stevenson, Lynne

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N2 - Background: Elevated left ventricular filling pressures present a major target of therapy for symptomatic heart failure but are difficult to assess directly. Because the relationship of left- and right-sided pressures remains ill defined in chronic heart failure, this study compared 3 right-sided measurements (right atrial [RA] pressure, pulmonary artery systolic [PAS] pressure, and severity of tricuspid regurgitation [TR]) to the pulmonary capillary wedge (PCW) pressure. Methods: Hemodynamic measurements and echocardiography were available from 1000 patients undergoing transplant evaluation. Right atrial and PAS pressure, and TR severity were compared to PCW pressure. For 754 patients undergoing repeat measurements, changes in RA and PAS pressures were compared to PCW changes.Results: Right atrial pressure correlated with PCW pressure (r = 0.64), regardless of etiology or TR severity. Right atrial pressure changes correlated with PCW changes (r = 0.62). Discordance was defined as either RA ≥ 10 mm Hg despite PCW < 22 mm Hg (6%) or RA < 10 mm Hg despite PCW ≥ 22 mm Hg (15%). For detection of PCW ≥ 22 mm Hg, positive predictive values were 88% for RA ≥ 10 mm Hg, 95% for PAS ≥ 60 mm Hg, and 79% for ≥ moderate TR. Pulmonary artery systolic 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 therapy of left ventricular filling pressures in approximately 80% of chronic heart failure patients without obvious non-cardiac disease. In this population, elevated PAS pressures are largely determined by elevated left-sided filling pressures. Copyright (C) 1999 International Society for Heart and Lung Transplantation.

AB - Background: Elevated left ventricular filling pressures present a major target of therapy for symptomatic heart failure but are difficult to assess directly. Because the relationship of left- and right-sided pressures remains ill defined in chronic heart failure, this study compared 3 right-sided measurements (right atrial [RA] pressure, pulmonary artery systolic [PAS] pressure, and severity of tricuspid regurgitation [TR]) to the pulmonary capillary wedge (PCW) pressure. Methods: Hemodynamic measurements and echocardiography were available from 1000 patients undergoing transplant evaluation. Right atrial and PAS pressure, and TR severity were compared to PCW pressure. For 754 patients undergoing repeat measurements, changes in RA and PAS pressures were compared to PCW changes.Results: Right atrial pressure correlated with PCW pressure (r = 0.64), regardless of etiology or TR severity. Right atrial pressure changes correlated with PCW changes (r = 0.62). Discordance was defined as either RA ≥ 10 mm Hg despite PCW < 22 mm Hg (6%) or RA < 10 mm Hg despite PCW ≥ 22 mm Hg (15%). For detection of PCW ≥ 22 mm Hg, positive predictive values were 88% for RA ≥ 10 mm Hg, 95% for PAS ≥ 60 mm Hg, and 79% for ≥ moderate TR. Pulmonary artery systolic 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 therapy of left ventricular filling pressures in approximately 80% of chronic heart failure patients without obvious non-cardiac disease. In this population, elevated PAS pressures are largely determined by elevated left-sided filling pressures. Copyright (C) 1999 International Society for Heart and Lung Transplantation.

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