From the Guidelines
The normal range for Left Atrial Pressure (LAP) is typically 6-12 mmHg, while the normal range for Left Ventricular End-Diastolic Pressure (LVEDP) is generally 8-12 mmHg. These pressures reflect the filling pressures of the left side of the heart and are important indicators of cardiac function. LAP represents the pressure in the left atrium, which receives oxygenated blood from the lungs, while LVEDP represents the pressure in the left ventricle just before contraction occurs.
Key Points to Consider
- These measurements are clinically significant because elevated values can indicate heart failure, mitral valve disease, or volume overload 1.
- Conversely, abnormally low values might suggest hypovolemia or certain restrictive cardiac conditions.
- The assessment of LV filling pressures is important in patients with HFrEF as it can successfully guide medical treatment 1.
- In patients with preserved EFs, the same initial evaluation of clinical presentation and 2D and color Doppler echocardiographic findings such as LVEF, regional wall motion abnormalities, LV hypertrophy, LA maximum volume index and significant mitral valve disease is performed to aid the assessment of LV diastolic function 1.
- Understanding these normal ranges helps clinicians assess cardiac function and guide treatment decisions for patients with suspected heart disease.
Parameters for Evaluation
- Mitral “L” velocity
- IVRT
- Pulsed-wave TDI-derived mitral annular early diastolic velocity: e′
- Mitral E/e′ ratio
- T E2e′ time interval
- LA maximum volume index
- Pulmonary veins: systolic (S) velocity, diastolic (D) velocity, and S/D ratio
- Ar-A duration
- CW Doppler TR systolic jet velocity
- CW Doppler PR end-diastolic velocity These parameters can be used to estimate LV filling pressures and guide the diagnosis of diastolic dysfunction 1.
From the Research
Normal Ranges for Left Atrial Pressure and LVEDP
- The normal range for Left Ventricular End-Diastolic Pressure (LVEDP) is generally considered to be less than 15 mmHg, as seen in studies where patients with LVEDP ≥15 mmHg had more significant increases in LVEDP and LAP/PAWP during balloon occlusion 2.
- A study found that the mean LVEDP for all patients was 23±9 mm Hg, and 75% of participants had an LVEDP >15 mm Hg 3.
- Another study used a cutoff of LVEDP = 18 mmHg to classify patients as having elevated or normal LVEDP 4.
- For Left Atrial Pressure (LAP), a study found that the median LAP was 13.5 mmHg, and none of the patients with a baseline LVEDP <15 mmHg had a LAP/PAWP >15 mmHg during balloon testing 2.
- Mean left atrial pressure (mLAP) was considered increased when it exceeded 18 mmHg in a study that validated echocardiographic parameters for assessing left ventricular filling pressure in patients with STEMI 5.
- The variability in LVEDP and LAP can be influenced by various factors, including infarct size, atherosclerotic burden, and comorbidities such as atrial fibrillation, hypertension, and coronary artery disease 3, 2.
Factors Influencing LVEDP and LAP
- LVEDP and LAP can be estimated using non-invasive methods, such as pulsed Doppler ultrasound 6 and machine-learning models based on femoral pressure waveform and electrocardiogram 4.
- Echocardiographic parameters, such as E/e' ratio, tricuspid regurgitation velocity, and left atrial volume index, can be correlated with mLAP, but require validation in specific patient populations, such as those with STEMI 5.
- Comorbidities typically associated with LV diastolic dysfunction, such as hypertension and coronary artery disease, are common in patients with elevated LVEDP and LAP, and should be considered in their management 2.