If PCWP is high, does the subsequent BNP override evidence provided by a heart catheterization? Which test is more accurate in diagnosing heart failure?
PCWP shows the pressure at that very point of time and may be suggestive of an acute event (Acute heart failure) while BNP builds up over time and may be high in chronic heart failure as well as in later phase of acute heart failure. So, PCWP is more accurate for acute heart failure and BNP is more accurate for chronic heart failure.
BNP may help you for the diagnosis of heart failure but is not sensitive enough to exclude it.
PCWP is a surrogate for EDLVP (or left atrial pressure). In some cases, accuracy of PCWP is debatable (See Halpern SD. et al, CHEST 2009) and should be confirmed by a proper EDLVP measurement with left heart catheterization.
BNP is a reflection of the LV end diastolic volume and pressure while PCWP is that of LA pressure. Heart failure is however a syndrome that involves the presence of symptoms and signs. Therefore, each of them should be looked at in conjunction with other features of cardiac hemodynamics.
PCWP reflects often the end-diastolic pressure of the left ventricle and will be assessed with other parameters (E/e1) and echocardiographic data. When exists a volume overload is possible to have both BNP and PCWP elevated and need to correlate with clinical symptoms and comorbidities.
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