Hortegal R; Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, MN, USA;
Reddy YNV; Jain CC; Borlaug BA; et al

Journal of Cardiac Failure. 32(8):1323-1332, 2026 Aug.

OBJECTIVES: Pulmonary artery wedge pressure (PAWP) and left ventricular
end-diastolic pressure (LVEDP) are central metrics for assessing filling
pressures. A moderate correlation between their resting values has been
reported, but their agreement during exercise and associated clinical
impact remain unclear. Moreover, their prognostic value is poorly
understood. The study’s objectives were to: (1) evaluate the correlation
between PAWP and LVEDP at rest and during peak exercise; and (2) assess
their ability to predict outcomes.

METHODS AND RESULTS: We studied a retrospective cohort of 161 patients
undergoing simultaneous resting and exercise PAWP and LVEDP measurements.
Associations among filling pressures, physiological variables, and
outcomes were evaluated. The primary endpoint was a composite of death,
hospitalization due to heart failure, or need for advanced heart failure
therapy. The cohort’s ages were 68 [53-76] years, and the body mass
indexes were 31.7 +/- 7.2 kg/m2; 49.1% were female. Resting PAWPs were 16
[11-20] mmHg, and LVEDPs were 19 [15-24] mmHg, increasing to 27 [21-32]
mmHg and 28 [23-34] mmHg during exercise, respectively. PAWPs and LVEDPs
showed moderate correlation (r=0.64 rest; r=0.67 exercise) and poor
agreement in detecting elevated filling pressures (Kappa rest 0.32;
exercise 0.39). PAWPs correlated better with other hemodynamic parameters
than LVEDPs, being associated with the composite outcome when >= 20 mmHg
at rest (hazard ratio 2.72, 95% confidence interval 1.42-5.19; P=0.002);
this persisted after adjusting for confounders. LVEDPs were not predictive
of the outcome.

CONCLUSIONS: PAWP was superior to LVEDP in identifying hemodynamic
abnormalities and the clinical endpoint, supporting emphasis on PAWP as
the primary metric of left heart filling pressures.