Pulmonary Arterial Wedge Pressure at Rest and During Exercise in Healthy Adults: A Systematic Review and Meta-analysis

• Published in: Journal of cardiac failure Vol. 25; no. 2; pp. 114 - 122
• Main Authors: Esfandiari, Sam, Wolsk, Emil, Granton, David, Azevedo, Lucas, Valle, Felipe Homem, Gustafsson, Finn, Mak, Susanna
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2019
• Subjects: exercise; healthy; Hemodynamics; pulmonary artery wedge pressure; pulmonary pressure; right heart catheterization; pulmonary artery wedge pressure; exercise; Hemodynamics; right heart catheterization; healthy; pulmonary pressure
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2018.10.009

The pulmonary arterial wedge pressure (PAWP) response to exercise may unmask latent heart failure with preserved ejection fraction. There remains a lack of consensus over threshold values for PAWP during exercise. A systematic review of studies examining PAWP by means of right heart catheterization at rest and during exercise in healthy individuals was performed.
Relevant data derived from healthy volunteers were stratified by age (older than 40 years vs 40 years or younger) and sex. Three exercise intensities were predefined: light, moderate, and strenuous. Weighted means and weighted 95% confidence intervals (CIs) for the aggregate data were calculated. A total of 424 individuals from 32 unique studies were included, of which 19% (n = 82) were female. PAWP reached weighted mean and 95% CI values of 19 (17–21) and 17 (16–18) mm Hg at light and moderate exercise, respectively. The PAWP response to exercise was similar between men and women >40 years of age. However, exercise intensities were lower in women.
PAWP increases during exercise, reaching up to 20 mm Hg in adults >40 years of age. Older women achieve PAWP values similar to those of older men, but at lower intensities. Findings support a threshold of at least 25 mm Hg as an absolute cutoff value for “normal” PAWP response to exercise in individuals >40 years old.