Direct left atrial hemodynamic pressure tracings obtained after transseptal puncture. (A) Prior to septostomy, demonstrating giant V waves to 39 mm Hg (red arrow). (B) Immediately after septostomy, demonstrating significantly decreased V wave to 20 mm Hg. (C) One-year postprocedure tracing showing sustained decrease in V wave pressure.
Hypothetical left atrial (LA) pressure–volume loops in this patient prior to septostomy (A) and after septostomy (B). The LA diastolic pressure–volume relationship is steep at higher volumes; thus, a small increase in LA volume in this range leads to a large increase in LA pressure with increase in the peak of the V wave. With the shunt induced by septostomy, LA volume shifts down to the more compliant range in the pressure–volume relationship, where V wave pressure amplitude is decreased.
Body mass, cardiac remodeling, and relationships between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and left ventricular (LV) filling pressures.A and B, Increased body mass was associated with larger right ventricular (RV) size and total heart volume. C, Pulmonary capillary wedge pressure (PCWP) was directly correlated with NT-proBNP in all patients with heart failure with preserved ejection fraction (HFpEF), but the relationship was shifted upward in obese HFpEF, indicating a higher PCWP for any value of NT-proBNP compared with nonobese HFpEF. (D) In contrast, the correlations between LV transmural pressure (LVTMP) and NT-proBNP did not differ in obese and nonobese HFpEF.
Correlations between left ventricular filling pressures, adiposity, and plasma volume. Elevations in left heart filling pressures were related to greater body mass (A) and plasma volume (B) in obese heart failure with preserved ejection fraction (HFpEF) but not in nonobese HFpEF. PCWP indicates pulmonary capillary wedge pressure.
