ISSN 2149-2263 | E-ISSN 2149-2271
Which Diastolic Pressure Should Be Used to Assess Diastolic Function? [Anatol J Cardiol]
Anatol J Cardiol. 2024; 28(3): 158-164 | DOI: 10.14744/AnatolJCardiol.2024.3713

Which Diastolic Pressure Should Be Used to Assess Diastolic Function?

Emre Aslanger1, Özlem Yıldırımtürk2, Dursun Akaslan3, Melih Öz2, Barış Güngör2, Halil Ataş3, Bülent Mutlu3
1Department of Cardiology, Health Sciences University, Başakşehir Pine and Sakura City Hospital, İstanbul, Türkiye
2Department of Cardiology, Health Sciences University, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
3Department of Cardiology, Marmara University, Pendik Training and Research Hospital, İstanbul, Türkiye

Background: Although high left ventricular filling pressures [left ventricular (LV) end-diastolic 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 (∆PTM). Clinically, preferring ∆PTM over PCWP may improve diagnostic and therapeutic decision-making. We aimed to compare the clinical implications of diastolic function characterization based on PCWP or ∆PTM.

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. ∆PTM-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 ∆PTM-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 ∆PTM instead of PCWP. As ∆PTM 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.

Keywords: Diastolic function, heart failure, hemodynamics, mortality, pressure–volume loop

Emre Aslanger, Özlem Yıldırımtürk, Dursun Akaslan, Melih Öz, Barış Güngör, Halil Ataş, Bülent Mutlu. Which Diastolic Pressure Should Be Used to Assess Diastolic Function?. Anatol J Cardiol. 2024; 28(3): 158-164

Corresponding Author: Emre Aslanger, Türkiye
Manuscript Language: English

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