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=Volume 8 - 2021

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=Background Right ventricular diastolic function influence on the hemodynamics of heart failure (HF). We aimed to clarify hemodynamic features of deep Y descent in the right atrial pressure waveform in patients with HF and preserved left ventricular systolic function.
Methods In total, 114 consecutive HF inpatients who had preserved left ventricular systolic function (left ventricular ejection fraction ≥50%) and right heart catheterization were retrospectively enrolled in this study. 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 7 patients (2 men, 5 women; mean age, 87±6) with HF and preserved ejection fraction and implanted a pacemaker to validate results of this study.
Results 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% p<0.001, median 8 vs 5 mmHg p=0.001, median 24 vs 21 mmHg p=0.036, median 33 vs 43 ml/m2 p<0.001, median 2.2 vs 2.7L/m2, p<0.001, respectively). Multiple linear regression revealed a negative correlation between stroke volume index and pulmonary vascular resistance index (wood unit*m2) only in patients with deep Y descent (estimated regression coefficient: -1.281, p=0.022). A positive correlation was also observed between cardiac index and heart rate in this group (r=0.321, p=0.038). In another 7 patients, increasing the heart rate (from median 60 to 80 /min, p=0.001) significantly reduced the BNP level (from median 419 to 335 pg/ml, p=0.005).
Conclusions The hemodynamics of HF patients 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.