Background:In ≈25% of patients with heart failure and reduced left-ventricular ejection fraction, right-ventricular (RV), and left-ventricular (LV) filling pressures are discordant (ie, one is elevated while the other is not). Whether clinical assessment allows detection of this discordance is unknown. We sought to determine the agreement of clinically versus invasively determined patterns of ventricular congestion.Methods:In 156 heart failure and reduced LV ejection fraction subjects undergoing invasive hemodynamic assessment, we categorized patterns of ventricular congestion (no congestion, RV only, LV only, or both) based on clinical findings of RV (jugular venous distention) or LV (hepatojugular reflux, orthopnea, or bendopnea) congestion. Agreement between clinically and invasively determined (RV congestion if right atrial pressure [RAP] ≥10 mm Hg and LV congestion if pulmonary capillary wedge pressure [PCWP] ≥22 mm Hg) categorizations was the primary end point.Results:The frequency of clinical patterns of congestion was: 51% no congestion, 24% both RV and LV, 21% LV only, and 4% RV only. Jugular venous distention had excellent discrimination for elevated RAP (C=0.88). However, agreement between clinical and invasive congestion patterns was poor, к=0.44 (95% CI, 0.34–0.55). While those with no clinical congestion usually had low RAP and PCWP (67/79, 85%), over one-half (24/38, 64%) with isolated LV clinical congestion had PCWP <22 mm Hg, most (5/7, 71%) with isolated RV clinical congestion had PCWP ≥22 mm Hg, and ≈one-third (10/32, 31%) with both RV and LV clinical congestion had elevated RAP but PCWP <22 mm Hg.Conclusions:While clinical examination allows accurate detection of elevated RAP, it does not allow accurate detection of discordant RV and LV filling pressures.

中文翻译：

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通过临床检查识别心力衰竭患者左右心室充盈压的不一致

背景：在约 25% 的左心室射血分数降低的心力衰竭患者中，右心室 (RV) 和左心室 (LV) 充盈压不一致（即，一个升高而另一个不升高）。临床评估是否允许检测这种不一致尚不清楚。我们试图确定临床与侵入性确定的心室充血模式的一致性。方法：在 156 名心力衰竭和左室射血分数降低的受试者中，我们对心室充血模式进行了分类（无充血、仅 RV、仅 LV 或两者）基于 RV（颈静脉扩张）或 LV（肝颈静脉反流、端坐呼吸或弯曲呼吸）充血的临床发现。主要终点是临床和有创确定（右心房压 [RAP] ≥10 mm Hg 时 RV 充血和肺毛细血管楔压 [PCWP] ≥22 mm Hg 时 LV 充血）分类之间的一致性。结果：临床模式的频率阻塞率为：51% 无阻塞，24% RV 和 LV，21% 仅 LV，4% 仅 RV。颈静脉扩张对 RAP 升高有很好的鉴别力（C=0.88）。然而，临床和侵入性充血模式之间的一致性很差，к=0.44（95% CI，0.34-0.55）。虽然没有临床充血的患者通常 RAP 和 PCWP 较低 (67/79, 85%)，但超过一半 (24/38, 64%) 的孤立性 LV 临床充血患者的 PCWP <22 mm Hg，大多数 (5/7 , 71%) 孤立性右室临床充血的 PCWP ≥ 22 mm Hg，约三分之一 (10/32,