Abstract 11909: Filling Pressure at Rest and During Exercise in Patients with Suspected High Filling Pressure Based on EAE/ASE Guidelines on Diastolic Dysfunction
Purpose: Recently EAE/ASE has suggested new criteria for identification of increased filling pressure based on diastolic E/e' and left atrial (LA) volume in patients with preserved systolic function. In the present study pulmonary capillary wedge pressure (PCWP) was assessed at rest and during exercise in patients with a recent AMI and filling pattern suggestive of increased filling pressure according to EAE/ASE guidelines and in a healthy control group with no signs of increased filling pressure.
Methods: Thirty three patients (age 62 ± 8, 83 % male) with a recent revascularized MI and LVEF> 45 %, E/e' 9-15 and LA > 34 ml/m2, underwent a symptom limited supine bicycle test with simultaneous right heart catheterization and echocardiography. Ten healthy volunteers (age 47 ± 5, 63 % male) served as controls. Hemodynamic parameters were measured at rest and peak exercise. A PCWP > 12 mmHg at rest and > 25 mmHg during exercise was considered abnormal.
Results: Patients had lower LVEF (54 ± 6 % vs LVEF 63 ± 3 %,P<0.001), higher E/e' (10.9 ± 2.8 vs 6.3 ± 2.3, p<0.001), and increased LA indexed maximal volume (43.4 ± 11.6 ml/m2 vs 29.7± 7.9ml/m2, p<0.001) compared with controls. In patients resting PCWP was 13.6 ± 4.3 mmHg and in 19 (54%) PCWP was abnormally increased. In controls resting PCWP was 8.9 ± 1.9 mmHg (p<0.004 compared with patients), and no controls had a resting PCWP >12 mmHg. At peak exercise PCWP increased to 35 ± 5.7 in patients and in all but 2 patients (94 %) PCWP was >25mmHg at peak exercise. No controls increased>25 mmHg during exercise.
Conclusion: Even though filling pressure at rest may be apparently normal in many patients where EAE/ASE guidelines for diastolic dysfunction suggest increased filling pressure, filling pressure during exercise in these patients is abnormally increased.
- © 2011 by American Heart Association, Inc.