From the Guidelines
Elevated left ventricular end-diastolic pressure (LVEDP) does not necessarily mean increased volume, though it can be related. LVEDP reflects the pressure in the left ventricle just before contraction and can be elevated due to multiple factors beyond just volume status, as noted in the 2021 guideline for the management of patients with valvular heart disease 1. While volume overload can cause elevated LVEDP, other conditions like decreased ventricular compliance, diastolic dysfunction, or heart failure with preserved ejection fraction can also increase LVEDP even with normal or low volume status. This distinction is clinically important because treating elevated LVEDP requires identifying the underlying cause. For instance, if LVEDP is high due to volume overload, diuretics may help, but if it's due to stiff ventricles from hypertrophy or fibrosis, diuretics might be less effective or even harmful. The relationship between pressure and volume in the heart follows the Frank-Starling mechanism, but this relationship becomes altered in diseased hearts, making pressure an unreliable indicator of volume status without additional clinical and echocardiographic information, as discussed in the context of heart failure diagnosis and management 1. Key factors to consider include LV systolic function, LV diastolic dysfunction parameters, and left atrial volume index, among others, to accurately assess the relationship between LVEDP and volume status 1. In clinical practice, it is essential to integrate these factors to guide treatment decisions, prioritizing the management of the underlying cause of elevated LVEDP to improve patient outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Relationship Between Elevated LVEDP and Volume
- Elevated left ventricular end-diastolic pressure (LVEDP) is an indicator of volume overload or abnormal diastolic function, suggesting a cardiac disorder 2.
- Studies have shown that LVEDP is associated with left atrial functional measures, such as total LA emptying fraction, passive LA emptying fraction, and active LA emptying fraction 3.
- However, the relationship between LVEDP and volume is not always straightforward, and LVEDP may not consistently predict volume overload 2.
Factors Influencing LVEDP and Volume Relationship
- Coronary artery disease and impaired LA mechanics can affect the relationship between LVEDP and volume 3.
- Age and vascular disease can also influence the association between LVEDP and LA functional measures 3.
- The use of LVEDP levels to guide fluid administration during coronary procedures does not always improve outcomes in comparison to other protocols 2.
Clinical Implications
- Elevated LVEDP can be a predictor of mortality and heart failure in patients with ST-segment elevation myocardial infarction (STEMI) 4.
- LVEDP can affect iFR and FFR measurements, leading to discordance, especially in patients with acute coronary syndrome (ACS) 5.
- Non-invasive parameters, such as E/e' and left ventricular global peak longitudinal diastolic strain rate, can predict elevated LVEDP and HFpEF patients 6.