What will be the pulmonary capillary wedge pressure ( PCWP ) in grade 1 LV diastolic dysfunction ?
- Significantly elevated
- Marginally elevated
- Usually Normal
- It depends upon age, LA size and LV function.
Answer is 3 . (Of course it depends on 4 ) Normal PCWP is 4-12mmhg
Are these patients with grade 1 LV diastolic dysfunction are at risk for acute pulmonary congestion at times of stress ?
Probably not ( in most )*
The grade 1 LV diastolic dysfunction or defect is the most used (abused ! ) echo terminology .The diagnostic simplicity of this condition namely a simple documentation of “a”velocity more than “e” , has made it as an epidemic in echo labs world wide. After all , it reflects a simple fact that left ventricle has summoned the atria for assistance (Which is all the more physiological at times of stress !)
When does this physiology becomes pathology ?
As long as the atria is doing its job of assisting the LV without any fuss , the mean pressure of LA(PCWP) is maintained within normal level . Only if the atrial function is stretched beyond the limits , PCWP begins to raise. It can happen in a variety of ways . Most commonly it happens elderly hypertensive /Diabetics especially with LVH .
It can also occur in healthy individuals when they become physically deconditioned. (Left ventricle goes for disuse and find it difficult to relax)
Isolated grade 1 LV diastolic dysfunction in people > 40 years generally do not indicate a serious abnormality.
Only if they have DM/HT and myocardial disease they need to be evaluated further.
One practical clue is , if LA size is normal one can rule out significant diastolic dysfunction.
* In elderly population , when they undergo any major surgery , presence of even grade 1 LV diastolic dysfunction can be a marker for peri -operative LVF and lung congestion .