Optimizing diastolic pressure gradient assessment

AIMS: The diastolic pressure gradient (DPG) has been proposed as a marker pulmonary vascular disease in the setting of left heart failure (HF). However, its diagnostic utility is compromised by the high prevalence of physiologically incompatible negative values (DPG(NEG)) and the contradictory evidence on its prognostic value. Pressure pulsatility impacts on DPG measurements, thus conceivably, pulmonary artery wedge pressure (PAWP) measurements insusceptible to the oscillatory effect of the V-wave might yield a more reliable DPG assessment. We set out to investigate how the instantaneous PAWP at the trough of the Y-descent (PAWP(Y)) influences the prevalence of DPG(NEG) and the prognostic value of the resultant DPG(Y). METHODS: Hundred and fifty-three consecutive HF patients referred for right heart catheterisation were enrolled prospectively. DPG, as currently recommended, was calculated. Subsequently, PAWP(Y) was measured and the corresponding DPG(Y) was calculated. RESULTS: DPG(Y) yielded higher values (median, IQR: 3.2, 0.6–5.7 mmHg) than DPG (median, IQR: 0.9, − 1.7–3.8 mmHg); p < 0.001. Conventional DPG was negative in 45% of the patients whereas DPG(Y) in only 15%. During follow-up (22 ± 14 months) 58 patients have undergone heart-transplantation or died. The predictive ability of DPG(Y) ≥ 6 mmHg for the above defined end-point events was significant [HR 2.1; p = 0.007] and independent of resting mean pulmonary artery pressure (PAP(M)). In contrast, conventional DPG did not comprise significant prognostic value following adjustment for PAP(M). CONCLUSION: Instantaneous pressures at the trough of Y-descent yield significantly fewer DPG(NEG) than conventional DPG and entail superior prognostic value in HF patients with and without PH. GRAPHIC ABSTRACT: [Image: see text] ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00392-020-01641-w) contains supplementary material, which is available to authorized users.