Elevated Pulmonary Artery Wedge Pressure in Group 1 Pulmonary Hypertension
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Le résumé fourni par la source
BACKGROUND: With pulmonary hypertension (PH), a pulmonary artery wedge pressure (PAWP)>15 mm Hg is used to diagnose left heart dysfunction, but some patients with adjudicated group 1 PH demonstrate PAWP>15 mm Hg. The primary objective of the study was to evaluate group 1 PH with high PAWP>15 mm Hg. METHODS: Patients with adjudicated group 1 PH from PVDOMICS between 2016 and 2019 were separated into high PAWP(>15 mm Hg) or normal PAWP and compared with adjudicated combined pre- and postcapillary (Cpc) PH related to heart failure with preserved ejection fraction (HFpEF). Participants underwent dynamic right heart catheterization and metabolomics. Findings were validated in 3 independent cohorts with adjudicated group 1 PH (validation cohorts 1 and 2 with exercise right heart catheterization and validation cohort 3 with resting right heart catheterization). RESULTS: Of 325 patients with group 1 PH (73% women, mean age 53.0±14.3 years), 15% (n=48) had high PAWP. Group 1 PH+high PAWP demonstrated greater obesity, left ventricular hypertrophy ( P <0.0002), left ventricular strain impairment ( P <0.0001), and decreased left ventricular compliance ( P <0.0001) compared with group 1 PH+normal PAWP, with changes comparable to Cpc-PH HFpEF (n=75). Compared with Cpc-PH HFpEF, left atrial function was better in group 1 PH+high PAWP with lower PAWP V wave, higher left atrial compliance, and left atrial ejection fraction ( P <0.0001 for all). Metabolomics demonstrated little difference between group 1 PH with high versus normal PAWP but large differences between group 1 PH+high PAWP versus Cpc-PH HFpEF (100 metabolites altered at false discovery rate P <0.05). Elevated PAWP was also observed in 18% of group 1 PH in the validation cohort 1 (n=402), with exercise PAWP response intermediately abnormal in group 1 PH+high PAWP relative to Cpc-PH HFpEF and group 1 PH+normal PAWP (interaction P <0.0001). Elevated PAWP was similarly observed in 22% and 19% of group 1 PH in validation cohorts 2 (n=55) and 3 (n=787), respectively. CONCLUSIONS: Approximately 1 in 5 adjudicated patients with group 1 PH has elevation in resting PAWP despite severe pulmonary vascular dysfunction and metabolomics consistent with traditionally defined group 1 PH. Despite resting PAWP elevation, these patients with group 1 PH were metabolomically and biologically distinct from Cpc PH HFpEF, with better left atrial function and diastolic reserve during exercise. These data emphasize the limitations of using resting PAWP alone to separate group 1 PH from HFpEF and call for development of more integrated clinical diagnostic criteria.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Elevated Pulmonary Artery Wedge Pressure in Group 1 Pulmonary Hypertension
- Date Crossref
- 31/03/2026
- Éditeur
- Ovid Technologies (Wolters Kluwer Health)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Mayo Clinic Department of Cardiovascular Medicine (Y.N.V.R. pays non établi dans la noticeÉtablissement de santé
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Mayo Clinic in Arizona pays non établi dans la noticeÉtablissement de santé
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Mayo Clinic in Florida pays non établi dans la noticeÉtablissement de santé
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University of Arizona Critical Care and Sleep Medicine pays non établi dans la noticeUniversité ou école supérieure
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Johns Hopkins University Division of Pulmonary and Critical Care Medicine pays non établi dans la noticeUniversité ou école supérieure
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Johns Hopkins Medicine pays non établi dans la noticeÉtablissement de santé
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Vanderbilt University Medical Center Pulmonary and Critical Care Medicine pays non établi dans la noticeÉtablissement de santé
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Cornell University pays non établi dans la noticeUniversité ou école supérieure
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Brigham and Women's Hospital Division of Cardiovascular Medicine pays non établi dans la noticeÉtablissement de santé
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Columbia University Irving Medical Center Department of Pediatrics and Medicine pays non établi dans la noticeÉtablissement de santé
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Columbia University pays non établi dans la noticeUniversité ou école supérieure
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Tufts Medical Center and Sleep Medicine pays non établi dans la noticeÉtablissement de santé
Department of Cardiovascular Medicine (Y.N.V.R. — Mayo Clinic, Mayo Clinic in Arizona et Mayo Clinic in Florida, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.