Mismatch between right- and left-sided filling pressures in heart failure patients with preserved ejection fraction

Background: Mismatch between right- and left-sided filling pressures is poorly understood in heart failure with preserved ejection fraction (HFpEF). Methods and results: We retrospectively analyzed 170 patients with HFpEF (EF >= 40%) who underwent right heart catheterization. Low match (right atrial pressure [RAP] < 10 mm Hg and pulmonary capillary wedge pressure [PCWP] < 10 mm Hg) was 76%, high match (RAP >= 10 mm Hg and PCWP >= 22 mm Hg) was 6.5%, high-R mismatch (RAP >= 10 mm Hg and PCWP b 22 mm Hg) was 12%, and high-L mismatch (RAP < 10 mm Hg and PCWP >= 22 mm Hg) was 5.9%. Elevated PCWP was a significant predictor of the composite endpoint of death or HF hospitalization within 12 months (hazard ratio 5.40, 95% confidence interval 2.17-12.5, p < 0.001). Elevated RAP was not significantly associated with worse outcomes. Pulmonary artery systolic pressure (PASP) and diastolic pressure (PADP) showed strong correlations with PCWP (PASP, r = 0.738, p < 0.001; PADP, r = 0.834, p < 0.001; RAP, r = 0.638, p < 0.001, respectively). Conclusions: Discordance exists between right- and left-sided filling pressures in HFpEF. Physiciansmay utilize pulmonary artery pressure to evaluate left-sided filling pressure, which is a significant predictor of prognosis. (C) 2017 Elsevier B.V. All rights reserved.