Cathcorlx

For hemodynamic confirmation of HFpEF, a 7F Swan-Ganz catheter (Baxter, Healthcare Corp, Munich, Germany) was inserted via a femoral approach^{22 (link)}. CathCorLX (Siemens AG, Erlangen, Germany) was used to measure pressures, which were recorded as average of eight measurements over eight recorded heart cycles. Cardiac output (CO) was assessed by thermodilution and by Fick’ s method. The transpulmonary pressure gradient (TPG) was calculated by subtracting pulmonary artery wedge pressure (PAWP) from mean pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) was calculated by dividing TPG by CO.

Invasive hemodynamic assessment was performed routinely in study participants before TTVR. Hemodynamic measurements were performed using a 7F Swan-Ganz catheter (Edwards Lifesciences GmbH, Austria) via femoral access. Pressures were documented as the average of eight measurements over eight consecutive heart cycles using CathCorLX (Siemens AG, Berlin and Munich, Germany). In addition to pulmonary artery Wedge pressure (PAWP), the systolic (sPAP), diastolic (dPAP), and mean (mPAP) PA pressures were documented. Cardiac output (CO) was measured by Fick's method or thermodilution. If both were available, Fick's method was preferred. Furthermore, the transpulmonary gradient (TPG) and diastolic pulmonary vascular pressure gradient (DPG) were calculated according to current guidelines (22 (link)). TPG was computed by subtracting PAWP from mPAP; DPG was calculated as the difference between dPAP and PAWP during a pull-back; pulmonary vascular resistance (PVR) was calculated by dividing TPG by CO. Precapillary PH was defined as mPAP ≥25mmHg and mPCWP ≤ 15 mmHg and combined pre-/postcapillary PH was defined as DPG ≥7mmHg or PVR ≥3 WU (Figure 1) (22 (link)). Moreover, coronary angiography was performed in all patients to detect possible coronary artery disease.

Hemodynamic parameters were assessed during right heart catheterization with a 7F Swan-Ganz catheter (Edwards Lifesciences, Irvine, CA, USA). Average pressures over eight heart cycles were used for analysis (CathCorLX (Siemens AG, Berlin and Munich, Germany)). Directly measured parameters were mean PAP (mPAP), pulmonary artery wedge pressure (PAWP), right atrial pressure (RAP), cardiac index (CI), and stroke volume index (SVi). Further parameters of interest, which included diastolic pressure gradient and pulmonary vascular resistance (PVR), were calculated according to standard formulae [16 (link)].

A 7 french Swan-Ganz catheter (Baxter, Irvine, CA, USA), inserted via either jugular or femoral access, was used for measurement of invasive hemodynamic parameters. Filling pressures were calculated as the average over eight heart cycles (CathCorLX, Siemens AG, Berlin and Munich, Germany). Hemodynamic parameters of interest were systolic pulmonary artery pressure (sPAP), diastolic pulmonary artery pressure (dPAP), mean pulmonary artery pressure (mPAP), PAWP, right atrial pressure, cardiac index, stroke volume index, diastolic pressure gradient (DPG), and pulmonary vascular resistance (PVR). DPG and PVR were calculated as follows: DPG = dPAP – PAWP, PVR = 80* [(mPAP − PAWP)/cardiac output].

For right heart catheterization a 7F Swan-Ganz catheter (Baxter, Irvine, CA) was inserted via a jugular or femoral access. Filling pressures were averaged after recording of eight heart cycles using CathCorLX (Siemens AG, Berlin and Munich, Germany). PAWP, pulmonary arterial pressure (PAP), and cardiac output (CO), were determined. CO was measured by both thermodilution and Fick method. Simultaneously, all patients underwent direct assessment of LV filling pressures, followed by coronary angiography. Standard formulae were used for the calculation of hemodynamic parameters[16 (link), 17 (link)].