Examining the Jugular Vein Is Never in Vain

Abstract

In this issue of Circulation: Heart Failure , Drazner et al1 report the findings of their study on the relationship of right and left ventricular (LV) filling pressures in patients with heart failure and preserved LV ejection fraction (HFPEF) (also referred to as heart failure with preserved systolic function, diastolic heart failure). They noted good concordance (79%) in this patient population between right atrial pressure (RAP), indicative of right ventricular filling pressure, and pulmonary artery occlusive pressure (pulmonary capillary wedge pressure [PCWP]), indicative of LV filling pressure. These pressures, modulated by various loading and unloading maneuvers, ranged from low to normal to high. Nonconcordance was noted in only 21% of the measurements, and, in these, the PCWP did not match the elevation of RAP. Article see p 202 The weaknesses and limitations of this study are overshadowed by its strengths. PCWP is not a direct measurement of left atrial pressure, and RAP and PCWP are not direct measurements of right and LV filling pressures, respectively. But their relationships (RAP to right ventricular filling pressure; PCWP to left atrial pressure and LV filling pressure) are closely linked, and correlations are generally quite high,2–5 such that RAP and PCWP are routinely used in clinical medicine as respective indicators of right and LV filling pressures. Only 11 patients with HFPEF were studied by Drazner et al.1 However, the study was performed in an experienced laboratory by seasoned investigators of human heart failure, using the standard techniques to generate a spectrum of ventricular-loading conditions. The lead author has a noteworthy record of studying fundamental hemodynamic questions in human heart failure.6–9 The question itself, namely the relationship between right and left heart filling pressures, had not been adequately examined in HFPEF. The favorable concordance of right and left heart filling pressures …