PCWP increases during exercise in patients with diastolic heart failure

During symptom-limited upright exercise, normal subjects have an increase in left ventricular end diastolic volume (LVEDV), associated with a modest increase in pulmonary capillary wedge pressure (PCWP) which remains within a normal range (red arrow). In contrast, patients with normal systolic function who have left ventricular hypertrophy, diastolic dysfunction, and a stiff, nondistensible left ventricle have a marked increase in PCWP with exercise, often to levels associated with pulmonary edema (blue arrow), but no change in LVEDV. This is consistent with exercise-induced ischemia and an exaggerated impairment of diastolic relaxation of the hypertrophied myocardium.