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Cardiogenic ShockHEARTNCT07163052

Hemodynamic Evaluation of Left Atrial Pressure in Relationship to Pulmonary Capillary Wedge Pressure in Cardio Thoracic Patients

An observational study of Cardiogenic Shock and Pulmonary Edema Cardiac Cause, run by Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA).

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

Accurate hemodynamic monitoring is critical in cardiothoracic surgery, where left atrial pressure (LAP) serves as the gold standard for assessing left-sided cardiac filling pressures. However, its invasive nature limits use, favoring pulmonary capillary wedge pressure (PCWP) via Swan-Ganz catheter as a surrogate. Read more about this study

Who is it for?
Ages 18 years and older
How many people
136 participants
Where
No sites listed yet
Study dates
1 Sep 2028to 1 Oct 2030
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Adult patients undergoing elective cardiac surgery for aortic valve regurgitation, mitral valve, coronary or aortic disease. We aim to include patients without significant impairment in cardiac function. Nonetheless, there are inherent primary and secondary effects of cardiac pathology leading to structural disease. The procedures, as noted in the inclusion criteria (4.2), are standard procedures in our hospital and are regularly performed. We want to select the patient from our wait list. No extra measures are taken to include the patients.

Who may be able to join

  • the primary procedure is cardiac surgery by median sternotomy
  • the use of CPB
  • patients undergoing aortic valve replacement (AVR) due to aortic regurgitation, mitral valve plasty (MVP), mitral valve repair (MVR), valve sparing aortic root replacement or supracoronary aorta ascendens replacement (SCAR)
  • left ventricular ejection fraction of 60% or more
  • no clinical or echocardiographic signs of preoperative decompensation cordis
  • only elective procedures

Who cannot join

  • patients with left ventricular hypertrophy (LVH), severe aortic stenosis or hypertrophic obstructive cardiomyopathy. LVH is defined as an increased LVMI greater than 95 grams per square meter (g/m²) in women and greater than 115 g/m² in men.
  • patients with echocardiographically observed RV or LV dilatation are assessed using specific criteria. For RV dilatation, a TAPSE of less than 14 millimeters or an RV FAC of less than 35% is indicative of dilatation. For LV dilatation, an LV end-diastolic (LVED) diameter greater than 2.7 centimeters per square meter or exceeding 117% of the predicted value, adjusted for age and body surface area, is considered dilated.
  • patients undergoing more than one type of procedure (i.e. double valve surgery, CABG and AVR)
  • postoperative aortic valve mean pressure gradient of more than 20 mm Hg and mitral valve mean pressure gradient of more than 5 mm Hg
  • postoperative paravalvular leak grade 2 or more
  • postoperative persistent regional wall abnormalities or electrocardiographic signs of acute ischemia
  • other significant valve pathology, such as moderate mitral regurgitation

Trial locations and contacts

No sites are listed yet. Contact the study team or a site near you to ask about taking part.

About this study

Accurate hemodynamic monitoring is critical in cardiothoracic surgery, where left atrial pressure (LAP) serves as the gold standard for assessing left-sided cardiac filling pressures. However, its invasive nature limits use, favoring pulmonary capillary wedge pressure (PCWP) via Swan-Ganz catheter as a surrogate. Despite widespread use, evidence on their agreement under dynamic conditions-such as varying cardiac index (CI) flows during cardiopulmonary bypass (CPB) or left ventricular (LV) unloading-remains inconsistent and unstudied in adult cardiac surgery.

Existing data show conflicting correlations: one study found that PCWP 35% higher than LAP in non-surgical patients, and another study found closer alignment in specific cohorts. This knowledge gap carries clinical urgency, as decisions on pulmonary edema management, vasopressor use, and LV decompression rely on these measurements.

Read more

Building on Laplace's law, we hypothesize that LV unloading reduces ventricular wall stress (afterload), lowering myocardial oxygen demand and altering the LAP-PCWP relationship. Elevated CI during CPB may further distort this interaction via increased pulmonary-left atrial pressure gradients.

The primary objective is to determine if PCWP reliably reflects LAP under standard CI-flow (2.4 L/min/m²) without unloading, using Bland-Altman analysis (±5 mmHg clinical margin). Secondary objectives assess agreement at other CI levels (1.8-2.6 L/min/m²), LV unloading effects, and patient/surgical variable impacts.

Read the detailed description

Effective hemodynamic monitoring is essential for optimizing postoperative management in cardiothoracic surgery. Left atrial pressure (LAP) is considered the gold standard for assessing left-sided cardiac filling pressures, but is typically measured directly only in selected cases due to its invasive nature. Pulmonary capillary wedge pressure (PCWP), measured via a Swan-Ganz catheter, is widely used as a less invasive surrogate for LAP. However, evidence suggests that the agreement between PCWP and directly measured LAP may vary under different hemodynamic conditions, particularly at higher cardiac index (CI) flow rates and with or without left ventricular (LV) unloading. To date, no in-vivo study has systematically quantified the agreement between these two methods in adult patients during cardiopulmonary bypass (CPB) at varying flow rates and unloading conditions.

Existing studies report inconsistent correlations between LAP and PCWP. For example, one study observed PCWP values 35% higher than LAP in non-surgical patients, while another study noted tighter correlations in specific cohorts. However, no in-vivo data exist for adult cardiac surgery patients under controlled CI-flow rates (+/- LV unloading). This gap is clinically critical, as decisions regarding pulmonary edema management, vasopressor use, and LV decompression rely on these measurements.

Building on Laplace's law, we hypothesize that LV unloading reduces ventricular wall stress (afterload), thereby lowering myocardial oxygen demand and improving recovery. Computational models and animal studies suggest that unloading decreases LV end-diastolic pressure (LVEDP) and left atrial (LA) volume, which may alter the LAP-PCWP relationship. Elevated CI during CPB could further modulate this interaction, as increased flow rates may exacerbate pressure gradients between the pulmonary vasculature and left atrium.

The primary objective of our study is therefore to determine whether PCWP can be considered an adequate surrogate for directly measured LAP under standard CI-flow (2.4 L/min/m²) without LV unloading, using a Bland-Altman analysis. Secondary objectives include evaluating the agreement between LAP and PCWP at other CI-flow rates and with LV unloading, as well as exploring the influence of patient characteristics and surgical variables. By addressing these questions, we hope to provide evidence to guide the interpretation of PCWP in clinical practice, potentially improving the safety and outcomes of patients undergoing cardiac surgery.

Keywords
LV unloading, post-cardiotomy shock, PCS, filling pressures
Medical subject headings
Shock, Cardiogenic, Heart Failure

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Study groups in NCT07163052
Study groupRoleWhat they receive
Total cohortPatients with and without LV unloading under different cardiac indeces via cardiopulmonary bypass

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Mean Difference (Bias) Between Left Atrial Pressure (LAP) and Pulmonary Capillary Wedge Pressure (PCWP) at a Cardiac Index of 2.4 L/min/m² Without LV Unloading

    Mean difference (bias) between invasively measured left atrial pressure (LAP, mmHg) and pulmonary capillary wedge pressure (PCWP, mmHg) at a fixed cardiac index of 2.4 L/min/m² without left ventricular unloading. Agreement will be assessed using Bland-Altman analysis. The mean difference (LAP minus PCWP) will be reported with 95% limits of agreement. PCWP will be considered an adequate surrogate for LAP if the 95% limits of agreement fall within ±5 mmHg. Unit of measure: mmHg.

    Measured: Intraoperatively

Secondary outcomes (13)
  1. Mean Difference (Bias) Between LAP and PCWP at Different Cardiac Index Flow Rates and LV Unloading Conditions

    Mean difference (bias) between invasively measured left atrial pressure (LAP, mmHg) and pulmonary capillary wedge pressure (PCWP, mmHg) for each cardiac index flow rate and LV unloading condition. Agreement will be assessed per condition using Bland-Altman analysis. The mean difference (LAP minus PCWP) will be reported with 95% limits of agreement. Unit of measure: mmHg.

    Measured: Intraoperatively

  2. Correlation Coefficient Between LAP and PCWP at Different Cardiac Index Flow Rates and LV Unloading Conditions

    Correlation between invasively measured left atrial pressure (LAP, mmHg) and pulmonary capillary wedge pressure (PCWP, mmHg) for each cardiac index flow rate and LV unloading condition. One correlation coefficient will be reported per condition, using Pearson's r or Spearman's ρ depending on data distribution. Unit of measure: correlation coefficient (unitless, range -1 to 1).

    Measured: Intraoperatively

  3. Change in Left Atrial Pressure (LAP) Before and After Mitral Valve Surgery

    Change in invasively measured left atrial pressure (LAP, mmHg) from before to after mitral valve surgery in mitral valve patients, calculated as the post-procedure value minus the pre-procedure value. Values will be compared using a paired t-test or Wilcoxon signed-rank test, depending on data distribution. Unit of measure: mmHg.

    Measured: Intraoperatively

  4. Change in Pulmonary Capillary Wedge Pressure (PCWP) Before and After Mitral Valve Surgery

    Change in invasively measured pulmonary capillary wedge pressure (PCWP, mmHg) from before to after mitral valve surgery in mitral valve patients, calculated as the post-procedure value minus the pre-procedure value. Values will be compared using a paired t-test or Wilcoxon signed-rank test, depending on data distribution. Unit of measure: mmHg.

    Measured: Intraoperatively

  5. Correlation Coefficient Between Echocardiographic Left Ventricular End-Diastolic Volume (LVEDV) and Invasive LAP and PCWP

    Correlation between left ventricular end-diastolic volume (LVEDV, mL), measured by echocardiography, and invasively measured left atrial pressure (LAP, mmHg) and pulmonary capillary wedge pressure (PCWP, mmHg). Two correlation coefficients will be reported (LVEDV vs LAP and LVEDV vs PCWP) using Pearson's r or Spearman's ρ, depending on data distribution. Unit of measure: correlation coefficient (unitless, range -1 to 1).

    Measured: Intraoperatively

  6. Correlation Coefficient Between Echocardiographic Left Ventricular Wall Thickness and Invasive LAP and PCWP

    Correlation between left ventricular wall thickness as a measure of LV hypertrophy (mm), measured by echocardiography, and invasively measured left atrial pressure (LAP, mmHg) and pulmonary capillary wedge pressure (PCWP, mmHg). Two correlation coefficients will be reported (wall thickness vs LAP and wall thickness vs PCWP) using Pearson's r or Spearman's ρ, depending on data distribution. Unit of measure: correlation coefficient (unitless, range -1 to 1).

    Measured: Intraoperatively

  7. Correlation Coefficient Between Echocardiographic Left Ventricular Ejection Fraction (LVEF) and Invasive LAP and PCWP

    Correlation between left ventricular ejection fraction (LVEF, %), measured by echocardiography, and invasively measured left atrial pressure (LAP, mmHg) and pulmonary capillary wedge pressure (PCWP, mmHg). Two correlation coefficients will be reported (LVEF vs LAP and LVEF vs PCWP) using Pearson's r or Spearman's ρ, depending on data distribution. Unit of measure: correlation coefficient (unitless, range -1 to 1).

    Measured: Intraoperatively

  8. Correlation Coefficient Between Echocardiographic E/e' Ratio and Invasive LAP and PCWP

    Correlation between the E/e' ratio (unitless), a measure of left-sided diastolic filling pressure measured by echocardiography, and invasively measured left atrial pressure (LAP, mmHg) and pulmonary capillary wedge pressure (PCWP, mmHg). Two correlation coefficients will be reported (E/e' vs LAP and E/e' vs PCWP) using Pearson's r or Spearman's ρ, depending on data distribution. Unit of measure: correlation coefficient (unitless, range -1 to 1).

    Measured: Intraoperatively

  9. Correlation Coefficient Between Echocardiographic Tricuspid Annular Plane Systolic Excursion (TAPSE) and Invasive LAP and PCWP

    Correlation between tricuspid annular plane systolic excursion (TAPSE, mm), a measure of right ventricular performance measured by echocardiography, and invasively measured left atrial pressure (LAP, mmHg) and pulmonary capillary wedge pressure (PCWP, mmHg). Two correlation coefficients will be reported (TAPSE vs LAP and TAPSE vs PCWP) using Pearson's r or Spearman's ρ, depending on data distribution. Unit of measure: correlation coefficient (unitless, range -1 to 1).

    Measured: Intraoperatively

  10. Correlation Coefficient Between Echocardiographic Mitral Regurgitation Grade and Invasive LAP and PCWP

    Correlation between mitral regurgitation severity (ordinal grade 1-4), graded by echocardiography, and invasively measured left atrial pressure (LAP, mmHg) and pulmonary capillary wedge pressure (PCWP, mmHg). Two correlation coefficients will be reported (MR grade vs LAP and MR grade vs PCWP) using Spearman's ρ, since MR grade is an ordinal variable. Unit of measure: correlation coefficient (unitless, range -1 to 1).

    Measured: Intraoperatively

  11. Correlation Coefficient Between Echocardiographic Left Atrial Volume Index (LAVI) and Invasive LAP and PCWP

    Correlation between left atrial volume index (LAVI, mL/m²), measured by echocardiography, and invasively measured left atrial pressure (LAP, mmHg) and pulmonary capillary wedge pressure (PCWP, mmHg). Two correlation coefficients will be reported (LAVI vs LAP and LAVI vs PCWP) using Pearson's r or Spearman's ρ, depending on data distribution. Unit of measure: correlation coefficient (unitless, range -1 to 1).

    Measured: Intraoperatively

  12. Correlation Coefficient Between Echocardiographic Right Atrial Volume Index (RAVI) and Invasive LAP and PCWP

    Correlation between right atrial volume index (RAVI, mL/m²), measured by echocardiography, and invasively measured left atrial pressure (LAP, mmHg) and pulmonary capillary wedge pressure (PCWP, mmHg). Two correlation coefficients will be reported (RAVI vs LAP and RAVI vs PCWP) using Pearson's r or Spearman's ρ, depending on data distribution. Unit of measure: correlation coefficient (unitless, range -1 to 1).

    Measured: Intraoperatively

  13. Correlation Coefficient Between Echocardiographic Left Ventricular Outflow Tract (LVOT) Dimensions and Invasive LAP and PCWP

    Correlation between left ventricular outflow tract (LVOT) dimensions (mm), measured by echocardiography, and invasively measured left atrial pressure (LAP, mmHg) and pulmonary capillary wedge pressure (PCWP, mmHg). Two correlation coefficients will be reported (LVOT dimensions vs LAP and LVOT dimensions vs PCWP) using Pearson's r or Spearman's ρ, depending on data distribution. Unit of measure: correlation coefficient (unitless, range -1 to 1).

    Measured: Intraoperatively

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Sep 2025
  2. Study start1 Sep 2028 (estimated)
  3. Primary completion1 Jun 2029 (estimated)
  4. Study completion1 Oct 2030 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
136 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07163052
Sponsor's protocol ID
HEART
Acronym
HEART
Status last verified
Oct 2026
First submitted
24 Aug 2025
Last updated
4 Nov 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

An observational study of Cardiogenic Shock and Pulmonary Edema Cardiac Cause, run by Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 4 Nov 2026. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact B U Baldan, MD (020 566 9111, b.u.baldan@amsterdamumc.nl), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Mean Difference (Bias) Between Left Atrial Pressure (LAP) and Pulmonary Capillary Wedge Pressure (PCWP) at a Cardiac Index of 2.4 L/min/m² Without LV Unloading (time frame: Intraoperatively). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Nov 2026.

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