Which Diastolic Pressure Should Be Used to Assess Diastolic Function?

Background: Although high left ventricular filling pressures [left ventricular (LV) enddiastolic pressure or pulmonary capillary wedge pressure (PCWP)] are widely taken as surrogates for LV diastolic dysfunction, the actual distending pressure that governs LV diastolic stretch is transmural pressure difference (ΔP_TM). Clinically, preferring ΔP_TM over PCWP may improve diagnostic and therapeutic decision-making. We aimed to compare the clinical implications of diastolic function characterization based on PCWP or ΔP_TM. Methods: We retrospectively screened our hospital database for adult patients with a clinical diagnosis of heart failure who underwent right heart catheterization. Echocardiographic diastolic dysfunction was graded according to the current guidelines. LV end-diastolic properties were assessed with construction of complete end-diastolic pressure-volume relationship (EDPVR) curves using the single-beat method. Survival status was checked via the electronic national health-care system. Results: A total of 693 cases were identified in our database; the final study population comprised 621 cases. ΔP_TM-based, but not PCWP-based, EDPVR diastolic stiffness constants were significantly predictive of advanced diastolic dysfunction. PCWP-based diastolic stiffness constants were not able to predict 5-year mortality, whereas ΔP_TM-based EDPVR stiffness constants and volumes all turned out to have significant predictive power for 5-year mortality. Conclusion: Left ventricular diastolic function assessment can be improved using ΔP_TM instead of PCWP. As ΔP_TM ultimately linked to right-sided functions, this approach emphasizes the limitations of taking LV diastolic function as an isolated phenomenon and underlines the need for a complete hemodynamic assessment involving the right heart in therapeutic and prognostic decision-making processes. [ABSTRACT FROM AUTHOR]