The DSM gain was decreased with NTG compared to placebo (0.57 vs 0.82 ml/mmHg, p<0.0001) suggesting a smaller change in SV for a change in filling pressure.Ĭonclusions: Lowering cardiac filling pressures in the seated upright position decreased efficiency of the beat-by-beat Starling mechanism. Results: Compared to placebo, NTG decreased both SV (Placebo: 53 ml vs NTG: 43 ml, p=0.004) and PAD (Placebo: 15.0 mmHg vs NTG: 13.9 mmHg, p=0.026). It is frequently used to assess left ventricular filling, as an indication of left atrial pressure, and to assess mitral valve function. Direct Fick SV was calculated as VO2/a-vO2 difference divided by heart rate. The pressure obtained when a catheter is passed from the right side of the heart into the pulmonary artery as far as it will go and wedged into an end artery. Pulmonary Capillary Wedge Pressure Explained Clinically, the PCWP is the pressure measured by wedging a pulmonary catheter with an inflated balloon into a small pulmonary arterial branch. DSM was quantified by transfer function analyses of beat-by-beat changes in pulmonary artery diastolic pressure (PAD, right heart catheterization as index for PCWP) and SV (Modelflow from radial arterial line waveform, normalized to direct Fick-derived SV) at the prevailing respiratory frequency. Some of them are Pulmonary Arterial Wedge Pressure (PAWP), Pulmonary Artery Occlusion Pressure (PAOP), or merely Pulmonary Wedge Pressure (PWP). Many other terms exist to refer to Pulmonary Capillary Wedge Pressure (PCWP). Methods: HFpEF patients (n=11, 7 women age 73 ± 7 years) were studied seated upright at rest following sublingual administration of placebo or NTG. Pulmonary Wedge Pressure refers to the pressure within the pulmonary arterial system. In this study, we examined the effect of sublingual nitroglycerin (NTG 400μg given q15 minutes) to lower PCWP compared to placebo on DSM. It is concluded that pulmonary artery pressure measurements are very important in monitoring intravenous fluid administration in severe shock. Low DSM gain reflects inefficient conversion of LV pressures (input) into stroke volume (output). The Dynamic Starling Mechanism (DSM) quantifies beat-by-beat modulation of stroke volume (SV) by respiratory-mediated changes in LV filling and provides insight into the efficiency with which changes in LV filling pressure are converted to SV. Multiple therapies aiming to reduce filling pressures in HFpEF patients have failed to improve exercise capacity and in some studies, decreased activity levels. Introduction: Elevated left ventricular (LV) filling pressure during exercise is a pathognomonic characteristic of HFpEF. Pulmonary wedge pressure is increased more than left atrial pressure after experimental burn injury due to postcapillary venular constriction. Customer Service and Ordering Information.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).

Pulmonary capillary wedge pressure