From the Guidelines
Left ventricular end-diastolic pressure (LVEDP) is the pressure in the left ventricle at the end of diastole, just before the start of systole.
Definition and Measurement
- LVEDP is an important parameter in assessing left ventricular diastolic function and can be estimated using various echocardiographic parameters, including Doppler signals that occur at end-diastole, such as mitral peak A velocity, A-wave duration, and tissue Doppler-derived mitral annular a′ velocity 1.
- These parameters can provide an estimate of LVEDP, which is essential in diagnosing and managing conditions such as heart failure and diastolic dysfunction.
Clinical Significance
- Elevated LVEDP is a strong indicator of diastolic dysfunction, which can lead to heart failure and other cardiovascular complications 1.
- Accurate measurement of LVEDP is crucial in guiding medical treatment and management of patients with heart failure and other cardiovascular conditions.
Echocardiographic Parameters
- Mitral peak A velocity, A-wave duration, and tissue Doppler-derived mitral annular a′ velocity are some of the echocardiographic parameters used to estimate LVEDP 1.
- Other parameters, such as mitral E-wave velocity, E/A ratio, and pulmonary vein peak Ar velocity, can also provide valuable information on left ventricular diastolic function and LVEDP 1.
Limitations and Considerations
- The accuracy of LVEDP estimation using echocardiographic parameters can be affected by various factors, such as heart rate, arterial pressure, and mitral valve disease 1.
- Therefore, it is essential to consider these factors and use a combination of parameters to obtain an accurate estimate of LVEDP.
From the Research
Definition of Left Ventricular End-Diastolic Pressure (LVEDP)
- LVEDP is an easily obtained, physiologically integrative measure of total left ventricular (LV) function 2.
- It is an important measure of ventricular performance and may identify patients at increased risk for developing late clinical symptoms of heart failure (HF) 3.
- LVEDP is a hemodynamic marker of left ventricular performance and affects coronary perfusion 4.
Clinical Significance of LVEDP
- Elevated LVEDP is associated with a higher risk of heart failure and mortality in patients with acute myocardial infarction 2, 4.
- LVEDP is a predictor of adverse outcomes, including death, in patients undergoing percutaneous coronary intervention (PCI) 4.
- LVEDP cannot be used interchangeably with mean left atrial pressure (LAP), as they have different clinical significance and may differ in magnitude in the presence of cardiac disease 5.
Measurement of LVEDP
- LVEDP can be measured directly by cardiac catheterization 2, 3.
- In mechanically ventilated patients with hyperinflation, LVEDP can be estimated from pulmonary artery occlusion pressure (PAOP) by calculating the transmural PAOP (tPAOP) 6.
- The use of terms like "left ventricular filling pressure" is ambiguous and should be abandoned in favor of using LVEDP or mean LAP as appropriate 5.