AUTHOR=Harada Daisuke , Asanoi Hidetsugu , Noto Takahisa , Takagawa Junya 

TITLE=The Impact of Deep Y Descent on Hemodynamics in Patients With Heart Failure and Preserved Left Ventricular Systolic Function

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.770923

DOI=10.3389/fcvm.2021.770923

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> Influence of right ventricular diastolic function on the hemodynamics of heart failure (HF). We aimed to clarify the hemodynamic features of deep Y descent in the right atrial pressure waveform in patients with HF and preserved left ventricular systolic function.</p><p><bold>Methods:</bold> In total, 114 consecutive inpatients with HF who had preserved left ventricular systolic function (left ventricular ejection fraction ≥ 50%) and right heart catheterization were retrospectively enrolled in this study. The patients were divided into two groups according to right atrial pressure waveform, and those with Y descent deeper than X descent in the right atrial pressure waveform were assigned to the deep Y descent group. We enrolled another seven patients (two men, five women; mean age, 87 ± 6) with HF and preserved ejection fraction, and implanted a pacemaker to validate the results of this study.</p><p><bold>Results:</bold> The patients with deep Y descent had a higher rate of atrial fibrillation, higher right atrial pressure and mean pulmonary arterial pressure, and lower stroke volume and cardiac index than those with normal Y descent (76 vs. 7% <italic>p</italic> &lt; 0.001, median 8 vs. 5 mmHg <italic>p</italic> = 0.001, median 24 vs. 21 mmHg <italic>p</italic> = 0.036, median 33 vs. 43 ml/m<sup>2</sup><italic>p</italic> &lt; 0.001, median 2.2 vs. 2.7 L/m<sup>2</sup>, <italic>p</italic> &lt; 0.001). Multiple linear regression revealed a negative correlation between stroke volume index and pulmonary vascular resistance index (wood unit*m<sup>2</sup>) only in the patients with deep Y descent (estimated regression coefficient: −1.281, <italic>p</italic> = 0.022). A positive correlation was also observed between cardiac index and heart rate in this group (r = 0.321, <italic>p</italic> = 0.038). In the other seven patients, increasing the heart rate (from median 60 to 80/min, <italic>p</italic> = 0.001) significantly reduced the level of BNP (from median 419 to 335 pg/ml, <italic>p</italic> = 0.005).</p><p><bold>Conclusions:</bold> The hemodynamics of patients with HF with deep Y descent and preserved left ventricular systolic function resembled right ventricular restrictive physiology. Optimizing the heart rate may improve hemodynamics in these patients.</p>