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However, its diagnostic utility is compromised by the high prevalence of physiologically incompatible negative values (DPG<jats:sub>NEG<\/jats:sub>) and the contradictory evidence on its prognostic value. Pressure pulsatility impacts on DPG measurements, thus conceivably, pulmonary artery wedge pressure (PAWP) measurements insusceptible to the oscillatory effect of the V-wave might yield a more reliable DPG assessment. We set out to investigate how the instantaneous PAWP at the trough of the <jats:italic>Y<\/jats:italic>-descent (PAWP<jats:sub><jats:italic>Y<\/jats:italic><\/jats:sub>) influences the prevalence of DPG<jats:sub>NEG<\/jats:sub> and the prognostic value of the resultant DPG<jats:sub><jats:italic>Y<\/jats:italic><\/jats:sub>.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Hundred and fifty-three consecutive HF patients referred for right heart catheterisation were enrolled prospectively. DPG, as currently recommended, was calculated. Subsequently, PAWP<jats:sub><jats:italic>Y<\/jats:italic><\/jats:sub> was measured and the corresponding DPG<jats:sub><jats:italic>Y<\/jats:italic><\/jats:sub> was calculated.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>DPG<jats:sub><jats:italic>Y<\/jats:italic><\/jats:sub> yielded higher values (median, IQR: 3.2, 0.6\u20135.7\u00a0mmHg) than DPG (median, IQR: 0.9,\u2009\u2212\u20091.7\u20133.8\u00a0mmHg); <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001. Conventional DPG was negative in 45% of the patients whereas DPG<jats:sub><jats:italic>Y<\/jats:italic><\/jats:sub> in only 15%. During follow-up (22\u2009\u00b1\u200914\u00a0months) 58 patients have undergone heart-transplantation or died. The predictive ability of DPG<jats:sub><jats:italic>Y<\/jats:italic><\/jats:sub>\u2009\u2265\u20096\u00a0mmHg for the above defined end-point events was significant [HR 2.1; <jats:italic>p<\/jats:italic>\u2009=\u20090.007] and independent of resting mean pulmonary artery pressure (PAP<jats:sub><jats:italic>M<\/jats:italic><\/jats:sub>). In contrast, conventional DPG did not comprise significant prognostic value following adjustment for PAP<jats:sub><jats:italic>M<\/jats:italic><\/jats:sub>.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Instantaneous pressures at the trough of <jats:italic>Y<\/jats:italic>-descent yield significantly fewer DPG<jats:sub>NEG<\/jats:sub> than conventional DPG and entail superior prognostic value in HF patients with and without PH.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Graphic abstract<\/jats:title>\n\n<\/jats:sec>","DOI":"10.1007\/s00392-020-01641-w","type":"journal-article","created":{"date-parts":[[2020,5,11]],"date-time":"2020-05-11T15:04:05Z","timestamp":1589209445000},"page":"1411-1422","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Optimizing diastolic pressure gradient assessment"],"prefix":"10.1007","volume":"109","author":[{"given":"Aristomenis","family":"Manouras","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonas","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars H","family":"Lund","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0519-5172","authenticated-orcid":false,"given":"Anik\u00f3 Ilona","family":"Nagy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,5,11]]},"reference":[{"key":"1641_CR1","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1161\/CIRCULATIONAHA.111.085761","volume":"126","author":"M Guazzi","year":"2012","unstructured":"Guazzi M, Borlaug BA (2012) Pulmonary hypertension due to left heart disease. 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