Comparison of PCWP and LVEDP Measurements in Patients with Severe Aortic Stenosis Undergoing TAVI—Same Same but Different?
Abstract
:1. Introduction
2. Methods
2.1. Patient Population
2.2. Procedure of RHC and LHC
2.3. Hemodynamic Definitions of PH
2.4. Transthoracic Echocardiography
2.5. TAVI Procedure
2.6. Clinical Follow Up and Study End Point
2.7. Statistical Analysis
3. Results
3.1. Patient Population
3.2. General Characteristics and Measurements
3.3. Linear Regression and Bland-Altman Analysis
3.4. Kaplan-Meier Curves
4. Discussion
4.1. Prevalances of PH and PH Subtypes Concerning PCWP and LVEDP Classification
4.2. Prec-PH via PCWP vs. LVEDP—Subgroup with Greatest Divergence in Terms of Hemodynamic Parameters and Mortality
4.3. Lack of Agreement between PCWP and LVEDP—Possible Reasons
5. Conclusions
6. Limitation
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
ANOVA | Analysis of variances |
AS | Aortic stenosis |
borderlinepc-PH | Borderline post-capillary pulmonary hypertension |
CO | Cardiac output |
cpc-PH | Combined post-capillary pulmonary hypertension |
dPAP | Diastolic pulmonary artery pressure |
DPG | Diastolic pressure gradient |
ESC | European Society of Cardiology |
ipc-PH | Isolated post-capillary pulmonary hypertension |
LHC | Left heart catheterization |
LVEDP | Left ventricular end-diastolic pressure |
LVEF | Left ventricular ejection fraction |
mPAP | Mean pulmonary artery pressure |
PCWP | Pulmonary capillary wedge pressure |
PH | Pulmonary hypertension |
prec-PH | Pre-capillary pulmonary hypertension |
PVR | Pulmonary vascular resistance |
RHC | Right hear catheterization |
sPAP | Systolic pulmonary artery pressure |
TAVI | Transcatheter aortic valve implantation |
TPG | Transpulmonary pressure gradient |
WHO | World Health Organization |
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Overall Cohort | No PH | Prec-PH | Ipc-PH | Borderlinepc-PH | Cpc-PH | ANOVA/Chi-Square | ||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
PCWP | LVEDP | PCWP | LVEDP | PCWP | LVEDP | PCWP | LVEDP | PCWP | LVEDP | |||||||||||||
n = 225 | n = 55 | n = 20 | n = 26 | n = 78 | n = 67 | n = 60 | n = 57 | n = 12 | n = 20 | |||||||||||||
Mean | SD (±) | Mean | SD (±) | Mean | SD (±) | Mean | SD (±) | Mean | SD (±) | Mean | SD (±) | Mean | SD (±) | Mean | SD (±) | Mean | SD (±) | Mean | SD (±) | p-Value | p-Value | |
Clinical data | ||||||||||||||||||||||
Age (years) | 80.89 | 7.03 | 80.53 | 6.52 | 83.90 | 6.02 | 83.77 | 7.30 | 80.36 | 7.56 | 79.67 | 7.13 | 80.70 | 7.00 | 82.44 | 6.20 | 81.83 | 7.21 | 77.80 | 8.24 | 0.328 | 0.010 |
Weight (kg) | 73.96 | 12.70 | 72.05 | 13.53 | 76.50 | 17.44 | 70.62 | 12.28 | 77.58 | 10.74 | 78.60 | 11.62 | 71.05 | 11.77 | 73.19 | 12.63 | 69.42 | 11.18 | 70.15 | 11.24 | 0.010 | 0.007 |
Height (cm) | 164.42 | 8.55 | 162.65 | 8.37 | 163.55 | 8.64 | 162.81 | 6.88 | 166.42 | 8.08 | 167.27 | 8.31 | 163.37 | 8.62 | 162.82 | 7.75 | 166.25 | 10.29 | 166.40 | 11.44 | 0.080 | 0.007 |
BMI (kg/m2) | 27.35 | 4.29 | 27.19 | 4.40 | 28.54 | 5.94 | 26.69 | 4.74 | 28.05 | 3.79 | 28.14 | 4.07 | 26.64 | 4.20 | 25.59 | 4.40 | 25.08 | 3.20 | 25.32 | 3.28 | 0.067 | 0.107 |
STS-Score | 4.01 | 2.48 | 3.54 | 2.20 | 4.86 | 3.25 | 4.75 | 3.16 | 3.88 | 2.56 | 3.69 | 2.24 | 4.31 | 2.18 | 4.38 | 2.39 | 4.09 | 2.99 | 4.35 | 3.01 | 0.242 | 0.131 |
EuroScore | 25.53 | 15.74 | 25.11 | 16.91 | 38.53 | 21.34 | 27.21 | 14.57 | 22.94 | 13.19 | 23.35 | 14.21 | 25.68 | 14.58 | 27.87 | 17.36 | 21.43 | 11.13 | 24.73 | 14.29 | 0.002 | 0.605 |
Laboratory data | ||||||||||||||||||||||
Creatinine (µmol/L) | 119.00 | 76.60 | 106.45 | 58.93 | 118.47 | 54.30 | 110.12 | 44.45 | 123.41 | 75.59 | 125.29 | 77.54 | 125.19 | 98.79 | 118.19 | 64.25 | 115.83 | 57.84 | 143.75 | 144.91 | 0.750 | 0.388 |
C-reactive protein (mg/L) | 19.10 | 34.38 | 12.37 | 24.13 | 16.14 | 20.05 | 30.80 | 39.07 | 20.19 | 37.40 | 19.75 | 36.53 | 25.92 | 43.36 | 18.48 | 30.08 | 15.42 | 20.52 | 20.32 | 49.67 | 0.384 | 0.310 |
Hemoglobin (mmol/L) | 7.54 | 1.07 | 7.55 | 0.99 | 7.68 | 0.80 | 7.46 | 1.16 | 7.39 | 1.00 | 7.34 | 1.05 | 7.64 | 1.25 | 7.78 | 1.02 | 7.69 | 1.39 | 7.59 | 1.32 | 0.704 | 0.347 |
Concomitant diseases | ||||||||||||||||||||||
Diabetes mellitus—no. (%) | 134 (59.60) | 31 (56.40) | 11 (55.00) | 15 (57.70) | 42 (53.80) | 39 (58.20) | 40 (66.66) | 33 (57.90) | 10 (83.33) | 16 (80.00) | 0.237 | 0.426 | ||||||||||
Arterial hypertension (%) | 205 (91.10) | 51 (92.70) | 19 (95.00) | 25 (96.20) | 69 (88.50) | 59 (88.10) | 55 (91.66) | 52 (91.20) | 11 (91.66) | 18 (90.00) | 0.869 | 0.773 | ||||||||||
Atrial fibrillation—no. (%) | 76 (33.80) | 18 (32.70) | 9 (45.00) | 8 (30.80) | 26 (33.33) | 25 (37.30) | 18 (30.00) | 18 (31.60) | 5 (41.70) | 7 (35.00) | 0.758 | 0.958 | ||||||||||
Coronary heart disease ≥ 2 vessels—no. (%) | 58 (25.80) | 12 (21.80) | 5 (25.00) | 5 (19.20) | 21 (26.90) | 20 (29.90) | 18 (30.00) | 14 (24.60) | 2 (16.66) | 7 (35.00) | 0.811 | 0.636 | ||||||||||
COPD—no. (%) | 50 (22.20) | 10 (18.20) | 5 (25.00) | 8 (30.80) | 18 (23.10) | 14 (20.90) | 13 (21.66) | 11 (19.30) | 4 (33.33) | 7 (35.00) | 0.825 | 0.426 | ||||||||||
Myocardial infarction—no. (%) | 29 (12.90) | 9 (16.40) | 1 (5.00) | 3 (11.50) | 8 (10.30) | 4 (6.00) | 9 (15.00) | 9 (15.80) | 2 (16.66) | 4 (20.00) | 0.643 | 0.321 | ||||||||||
Stroke—no. (%) | 32 (14.20) | 6 (10.90) | 5 (25.00) | 9 (34.60) | 14 (17.90) | 10 (14.90) | 6 (10.00) | 6 (10.50) | 1 (8.33) | 1 (5.00) | 0.342 | 0.022 | ||||||||||
NYHA ≥ III—no. (%) | 186 (82.70) | 41 (74.50) | 16 (80.00) | 23 (88.50) | 66 (84.60) | 57 (85.10) | 54 (90.00) | 47 (82.50) | 9 (75.00) | 18 (90.00) | 0.183 | 0.238 | ||||||||||
Echocardiographic data | ||||||||||||||||||||||
EF (%) | 57.57 | 16.14 | 61.02 | 15.64 | 61.70 | 10.46 | 56.87 | 13.90 | 57.96 | 15.61 | 57.96 | 15.43 | 52.89 | 17.69 | 58.50 | 16.13 | 55.59 | 18.17 | 44.97 | 18.22 | 0.064 | 0.006 |
LVEDD (mm) | 48.70 | 7.81 | 47.38 | 8.17 | 47.26 | 6.84 | 47.72 | 7.04 | 49.20 | 7.01 | 49.97 | 7.43 | 49.43 | 8.05 | 47.74 | 7.50 | 50.58 | 10.74 | 52.16 | 8.85 | 0.465 | 0.092 |
LVESD (mm) | 32.14 | 9.27 | 30.00 | 9.51 | 30.69 | 7.47 | 31.69 | 8.99 | 32.04 | 8.34 | 33.09 | 8.91 | 34.03 | 9.87 | 30.50 | 8.18 | 36.38 | 12.34 | 40.46 | 9.32 | 0.224 | 0.005 |
sPAP (mmHg) | 41.55 | 13.79 | 32.61 | 7.66 | 33.15 | 12.35 | 40.29 | 11.81 | 43.91 | 11.64 | 41.40 | 12.47 | 47.25 | 15.55 | 47.47 | 14.86 | 52.40 | 13.85 | 50.60 | 15.98 | < 0.001 | < 0.001 |
AVA (cm2) | 0.65 | 0.18 | 0.67 | 0.21 | 0.64 | 0.19 | 0.65 | 0.18 | 0.67 | 0.17 | 0.68 | 0.18 | 0.61 | 0.15 | 0.61 | 0.15 | 0.66 | 0.22 | 0.60 | 0.14 | 0.351 | 0.295 |
AV max (m/s) | 4.34 | 0.71 | 4.51 | 0.69 | 4.37 | 0.46 | 4.20 | 0.63 | 4.30 | 0.63 | 4.33 | 0.65 | 4.23 | 0.86 | 4.35 | 0.76 | 4.33 | 0.73 | 4.09 | 0.82 | 0.281 | 0.153 |
AV dpmax (mmHg) | 78.96 | 26.42 | 83.52 | 24.59 | 77.69 | 15.71 | 70.16 | 18.14 | 77.12 | 23.04 | 76.91 | 23.00 | 76.87 | 33.63 | 83.44 | 32.01 | 81.08 | 30.09 | 71.96 | 30.86 | 0.654 | 0.101 |
AV dpmean (mmHg) | 47.97 | 16.65 | 51.03 | 16.90 | 47.39 | 11.87 | 42.65 | 18.14 | 46.35 | 13.97 | 47.53 | 14.46 | 47.12 | 20.40 | 49.37 | 19.50 | 48.80 | 18.87 | 43.85 | 18.01 | 0.603 | 0.195 |
Mitral regurgitation ≥ II°—no. (%) | 99 (44.00) | 20 (36.40) | 2 (10.00) | 11 (42.30) | 35 (44.90) | 26 (38.80) | 39 (65.00) | 32 (56.10) | 3 (25.00) | 10 (50.00) | < 0.001 | 0.275 | ||||||||||
Tricuspid regurgitation ≥ II°—no. (%) | 95 (42.20) | 19 (34.50) | 6 (30.00) | 14 (53.80) | 34 (43.60) | 27 (40.30) | 29 (48.33) | 21 (36.80) | 7 (58.33) | 14 (70.00) | 0.439 | 0.044 | ||||||||||
RHC & LHC data | ||||||||||||||||||||||
RA (mmHg) | 10.41 | 5.53 | 5.44 | 3.24 | 7.89 | 2.79 | 10.63 | 3.83 | 12.47 | 4.70 | 11.18 | 3.94 | 12.66 | 5.51 | 12.16 | 5.95 | 13.33 | 6.11 | 16.83 | 5.36 | < 0.001 | < 0.001 |
RV (mmHg) | 9.26 | 6.55 | 4.43 | 3.87 | 7.16 | 3.62 | 9.09 | 5.74 | 11.19 | 6.44 | 9.81 | 6.25 | 12.05 | 6.86 | 11.84 | 6.67 | 9.58 | 6.57 | 13.89 | 6.35 | < 0.001 | < 0.001 |
sPAP (mmHg) | 52.77 | 17.93 | 33.91 | 6.53 | 43.95 | 7.10 | 53.92 | 14.42 | 55.30 | 14.25 | 51.81 | 12.45 | 65.83 | 14.44 | 64.63 | 25.47 | 72.17 | 20.03 | 72.55 | 16.74 | < 0.001 | < 0.001 |
mPAP (mmHg) | 33.64 | 11.77 | 19.95 | 3.42 | 27.40 | 2.66 | 34.92 | 8.76 | 35.79 | 8.13 | 33.27 | 6.76 | 42.10 | 89.76 | 41.07 | 9.34 | 50.50 | 11.61 | 49.70 | 8.49 | < 0.001 | < 0.001 |
dPAP (mmHg) | 19.87 | 8.83 | 10.16 | 4.24 | 16.80 | 2.63 | 21.31 | 6.69 | 21.62 | 6.62 | 19.76 | 5.20 | 24.53 | 6.72 | 24.05 | 7.62 | 34.75 | 8.32 | 33.10 | 5.72 | < 0.001 | < 0.001 |
PCWP (mmHg) | 21.12 | 9.16 | 11.09 | 4.03 | 13.05 | 1.70 | 20.42 | 5.47 | 25.14 | 7.19 | 22.39 | 6.61 | 26.92 | 7.05 | 25.91 | 8.79 | 25.33 | 7.62 | 31.65 | 6.44 | < 0.001 | < 0.001 |
DPGPCWP (mmHg) | −1.23 | 5.69 | −0.93 | 4.97 | 3.75 | 2.84 | 0.88 | 5.78 | −3.53 | 4.43 | −2.63 | 4.71 | −2.38 | 5.27 | −1.77 | 6.33 | 9.83 | 3.61 | 1.45 | 7.06 | < 0.001 | 0.011 |
DPGLVEDP (mmHg) | −1.76 | 10.65 | −9.76 | 7.50 | −2.95 | 7.77 | 9.46 | 7.25 | −1.95 | 9.99 | −5.73 | 8.08 | 3.03 | 8.74 | 0.28 | 7.81 | 14.08 | 9.99 | 13.10 | 6.63 | < 0.001 | < 0.001 |
TPGPCWP (mmHg) | 12.52 | 5.98 | 8.85 | 3.29 | 14.35 | 3.00 | 14.50 | 6.45 | 10.65 | 3.69 | 10.88 | 2.99 | 15.18 | 5.73 | 15.16 | 6.29 | 25.17 | 8.80 | 18.05 | 9.05 | < 0.001 | < 0.001 |
TPGLVEDP (mmHg) | 12.01 | 12.97 | 0.02 | 8.78 | 7.65 | 7.77 | 23.07 | 9.22 | 12.23 | 11.02 | 7.78 | 8.94 | 20.60 | 9.09 | 17.30 | 8.79 | 29.83 | 12.19 | 29.70 | 9.34 | < 0.001 | < 0.001 |
PVR (WU) | 3.25 | 2.15 | 2.64 | 1.58 | 3.11 | 1.08 | 3.55 | 2.89 | 1.83 | 0.63 | 1.91 | 0.64 | 5.02 | 2.28 | 4.34 | 2.13 | 6.00 | 2.50 | 5.77 | 1.99 | < 0.001 | < 0.001 |
CO (L/min) | 4.19 | 1.18 | 4.18 | 1.32 | 4.22 | 1.06 | 3.95 | 9.54 | 4.62 | 1.14 | 4.65 | 1.01 | 3.68 | 1.00 | 3.85 | 1.18 | 3.91 | 0.83 | 3.91 | 1.20 | < 0.001 | 0.002 |
LVEDP | 21.63 | 7.89 | 19.93 | 7.46 | 19.75 | 7.32 | 11.85 | 2.77 | 23.56 | 8.15 | 25.49 | 7.40 | 21.50 | 7.92 | 23.77 | 7.19 | 20.67 | 7.18 | 20.00 | 3.80 | 0.071 | < 0.001 |
Procedurale data | ||||||||||||||||||||||
Transfemoral approach—no. (%) | 193 (85.80) | 48 (87.30) | 18 (90.00) | 22 (84.60) | 65 (83.30) | 58 (86.60) | 52 (86.66) | 48 (84.20) | 10 (83.33) | 17 (85.00) | 0.928 | 0.991 | ||||||||||
CoreValve—no. (%) | 57 (25.30) | 11 (20.00) | 7 (35.00) | 9 (34.60) | 22 (28.20) | 17 (25.40) | 14 (23.33) | 15 (26.30) | 3 (25.00) | 5 (25.00) | 0.684 | 0.728 | ||||||||||
JenaValve—no. (%) | 28 (12.40) | 7 (12.70) | 1 (5.00) | 3 (11.50) | 10 (12.80) | 7 (10.40) | 8 (13.33) | 8 (14.00) | 2 (16.66) | 3 (15.00) | 0.866 | 0.971 | ||||||||||
Edwards—no. (%) | 138 (61.30) | 37 (67.30) | 12 (60.00) | 14 (53.80) | 45 (57.70) | 43 (64.20) | 37 (61.66) | 32 (56.10) | 7 (58.33) | 12 (60.00) | 0.858 | 0.676 | ||||||||||
Major vascular complications—no. (%) | 25 (11.10) | 8 (14.50) | 2 (10.00) | 2 (7.70) | 6 (7.7) | 4 (6.00) | 7 (11.66) | 8 (14.00) | 2 (16.66) | 3 (15.00) | 0.736 | 0.469 |
R | R2 | F | B | B (SE) | Beta | p-Value | |
---|---|---|---|---|---|---|---|
Overall cohort | 0.210 | 0.044 | 10.292 | 0.244 | 0.076 | 0.210 | 0.002 |
mPAP < 25 mmHg | 0.117 | 0.014 | 0.739 | −0.063 | 0.074 | −0.117 | 0.394 |
mPAP ≥ 25 mmHg | 0.220 | 0.048 | 8.556 | 0.219 | 0.075 | 0.220 | 0.004 |
Age < 80 years | 0.210 | 0.044 | 3.601 | 0.246 | 0.130 | 0.210 | 0.061 |
Age ≥ 80 years | 0.195 | 0.038 | 5.678 | 0.226 | 0.095 | 0.195 | 0.018 |
BMI < 30 kg/m2 | 0.253 | 0.064 | 11.189 | 0.288 | 0.086 | 0.253 | 0.001 |
BMI ≥ 30 kg/m2 | 0.104 | 0.011 | 0.622 | 0.135 | 0.171 | 0.104 | 0.433 |
Creatinine < 132 µmol/l | 0.238 | 0.057 | 9.320 | 0.266 | 0.087 | 0.238 | 0.003 |
Creatinine ≥ 132 µmol/l | 0.357 | 0.127 | 7.012 | 0.540 | 0.204 | 0.357 | 0.011 |
No Diabetes | 0.244 | 0.059 | 5.617 | 0.278 | 0.117 | 0.244 | 0.020 |
Diabetes | 0.186 | 0.034 | 4.710 | 0.220 | 0.101 | 0.186 | 0.032 |
No Hypertension | 0.090 | 0.008 | 0.148 | 0.151 | 0.392 | 0.090 | 0.705 |
Hypertension | 0.224 | 0.050 | 10.697 | 0.251 | 0.077 | 0.224 | 0.001 |
No Atrial Fibrillation | 0.207 | 0.043 | 6.613 | 0.233 | 0.090 | 0.207 | 0.011 |
Atrial Fibrillation | 0.216 | 0.047 | 3.633 | 0.272 | 0.143 | 0.216 | 0.061 |
Coronary Heart Disease < 2 vessels | 0.222 | 0.049 | 8.580 | 0.261 | 0.089 | 0.222 | 0.004 |
Coronary Heart Disease ≥ 2 vessels | 0.163 | 0.027 | 1.532 | 0.182 | 0.147 | 0.163 | 0.221 |
No COPD | 0.241 | 0.058 | 10.713 | 0.276 | 0.084 | 0.241 | 0.001 |
COPD | 0.088 | 0.008 | 21.235 | 0.108 | 0.176 | 0.088 | 0.542 |
No Myocardial Infarction | 0.221 | 0.049 | 9.923 | 0.252 | 0.080 | 0.221 | 0.002 |
Myocardial Infarction | 0.095 | 0.009 | 0.248 | 0.126 | 0.252 | 0.095 | 0.622 |
No Stroke | 0.202 | 0.041 | 8.119 | 0.237 | 0.083 | 0.202 | 0.005 |
Stroke | 0.271 | 0.074 | 2.384 | 0.309 | 0.200 | 0.271 | 0.133 |
NYHA < III | 0.027 | 0.001 | 0.019 | 0.036 | 0.265 | 0.027 | 0.893 |
NYHA ≥ III | 0.267 | 0.071 | 14.126 | 0.308 | 0.082 | 0.267 | < 0.001 |
EF < 50% | 0.261 | 0.068 | 4.526 | 0.323 | 0.152 | 0.261 | 0.037 |
EF ≥ 50% | 0.110 | 0.012 | 1.834 | 0.122 | 0.090 | 0.110 | 0.178 |
Mitral Regurgitation < II° | 0.107 | 0.012 | 1.356 | 0.116 | 0.099 | 0.107 | 0.247 |
Mitral Regurgitation ≥ II° | 0.326 | 0.106 | 11.514 | 0.397 | 0.117 | 0.326 | 0.001 |
Tricuspid Regurgitation < II° | 0.284 | 0.081 | 9.664 | 0.337 | 0.108 | 0.284 | 0.002 |
Tricuspid Regurgitation ≥ II° | 0.200 | 0.040 | 3.857 | 0.240 | 0.122 | 0.200 | 0.053 |
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Boxhammer, E.; Mirna, M.; Bäz, L.; Alushi, B.; Franz, M.; Kretzschmar, D.; Hoppe, U.C.; Lauten, A.; Lichtenauer, M. Comparison of PCWP and LVEDP Measurements in Patients with Severe Aortic Stenosis Undergoing TAVI—Same Same but Different? J. Clin. Med. 2022, 11, 2978. https://doi.org/10.3390/jcm11112978
Boxhammer E, Mirna M, Bäz L, Alushi B, Franz M, Kretzschmar D, Hoppe UC, Lauten A, Lichtenauer M. Comparison of PCWP and LVEDP Measurements in Patients with Severe Aortic Stenosis Undergoing TAVI—Same Same but Different? Journal of Clinical Medicine. 2022; 11(11):2978. https://doi.org/10.3390/jcm11112978
Chicago/Turabian StyleBoxhammer, Elke, Moritz Mirna, Laura Bäz, Brunilda Alushi, Marcus Franz, Daniel Kretzschmar, Uta C. Hoppe, Alexander Lauten, and Michael Lichtenauer. 2022. "Comparison of PCWP and LVEDP Measurements in Patients with Severe Aortic Stenosis Undergoing TAVI—Same Same but Different?" Journal of Clinical Medicine 11, no. 11: 2978. https://doi.org/10.3390/jcm11112978
APA StyleBoxhammer, E., Mirna, M., Bäz, L., Alushi, B., Franz, M., Kretzschmar, D., Hoppe, U. C., Lauten, A., & Lichtenauer, M. (2022). Comparison of PCWP and LVEDP Measurements in Patients with Severe Aortic Stenosis Undergoing TAVI—Same Same but Different? Journal of Clinical Medicine, 11(11), 2978. https://doi.org/10.3390/jcm11112978