What is a normal Left Ventricular End-Diastolic Pressure (LVEDP)?

Normal Left Ventricular End-Diastolic Pressure (LVEDP)

Normal LVEDP is typically below 12 mm Hg, with values above 18 mm Hg considered elevated and indicative of left ventricular dysfunction. 1

Normal LVEDP Values and Clinical Significance

• Normal LVEDP ranges from 5-12 mm Hg, with values above 12 mm Hg beginning to suggest abnormal left ventricular filling pressures 2
• In patients with left ventricular failure, LVEDP is usually elevated above 18 mm Hg 1
• LVEDP values ≥24 mm Hg are associated with the highest risk for adverse outcomes, including early and late mortality 3
• An LVEDP ≥26 mm Hg in patients undergoing elective percutaneous coronary intervention is associated with significantly higher in-hospital mortality rates (1.5% vs 0.3-0.4% for lower LVEDP values) 2

Clinical Implications of Elevated LVEDP

• Elevated LVEDP is an independent predictor of adverse outcomes in patients with ST-segment elevation myocardial infarction (STEMI), even after adjustment for baseline left ventricular ejection fraction 3
• In heart failure, LVEDP correlates with pulmonary capillary wedge pressure (PCWP), though these measurements are not always identical throughout the cardiac cycle 4
• The relationship between LVEDP and PCWP can be affected by:
  • Early stages of diastolic dysfunction (when LVEDP is elevated while mean PCWP remains normal) 4
  • Different phases of the cardiac cycle (creating natural gradients) 4
  • Mechanical ventilation (positive pressure affects the relationship) 4

Assessment of LVEDP

• LVEDP is directly measured during left heart catheterization 1
• Echocardiographic parameters can estimate LVEDP non-invasively:
  • E/e' ratio >15 usually indicates high LV filling pressures 1
  • E/e' ratio <8 usually indicates normal LV filling pressures 1
  • Mitral inflow E/A ratio >2 suggests restrictive filling with high LV filling pressures 1
  • Left atrial volume index >34 mL/m² suggests chronically elevated filling pressures 1

Prognostic Value of LVEDP

• In STEMI patients, elevated LVEDP (>18 mm Hg) is associated with:
  • 2-fold higher risk of 30-day mortality 5, 3
  • 2.9-fold higher risk of heart failure 5
  • 1.57-fold higher risk of 2-year mortality 3
• In patients undergoing elective or urgent PCI, elevated LVEDP (>18 mm Hg) is associated with higher rates of in-hospital adverse outcomes, including death 2

Common Pitfalls in LVEDP Assessment

• Only a weak correlation exists between LVEDP and left ventricular ejection fraction (LVEF), meaning normal LVEF does not exclude elevated LVEDP 3
• LVEDP may be "pseudo-normal" in patients treated with diuretics, potentially masking underlying diastolic dysfunction 1
• Heart rate and rhythm abnormalities can significantly affect LVEDP assessment 4
• Age-related changes in diastolic function must be considered when interpreting LVEDP values 1, 4

Clinical Applications

• LVEDP measurement is particularly valuable in:
  • Differentiating pre-capillary pulmonary arterial hypertension (LVEDP <15 mmHg) from pulmonary hypertension due to left heart disease (LVEDP >15 mmHg) 1
  • Assessing risk for post-myocardial infarction heart failure 5
  • Evaluating patients before heart transplantation to identify those at higher risk of acute post-operative right ventricular failure 1