The influence of right heart catheterisation on pulmonary arterial pressure in chronic heart failure: relationship to neuroendocrinal changes

1991 ◽  
Vol 33 (3) ◽  
pp. 365-376 ◽  
Author(s):  
J.Simon R. Gibbs ◽  
Roberto Ferrari ◽  
Jennifer Keegan ◽  
Cesari Ceconi ◽  
Christine Wright ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Arterial Pressure ◽  
Pulmonary Arterial Pressure ◽  
Right Heart ◽  
Heart Catheterisation ◽  
Right Heart Catheterisation ◽  
Pulmonary Arterial

scholarly journals Determinants and prognostic value of pulmonary arterial pressure in patients with chronic heart failure

2010 ◽  
Vol 31 (18) ◽  
pp. 2280-2290 ◽  
Author(s):  
Thibaud Damy ◽  
Kevin M. Goode ◽  
Anna Kallvikbacka-Bennett ◽  
Christian Lewinter ◽  
James Hobkirk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Arterial Pressure ◽  
Prognostic Value ◽  
Pulmonary Arterial Pressure ◽  
Pulmonary Arterial

scholarly journals Right heart catheterisation: best practice and pitfalls in pulmonary hypertension

2015 ◽  
Vol 24 (138) ◽  
pp. 642-652 ◽  
Author(s):  
Stephan Rosenkranz ◽  
Ioana R. Preston
Keyword(s):  
Pulmonary Hypertension ◽  
Clinical Practice ◽  
Best Practice ◽  
Data Interpretation ◽  
Volume Measurement ◽  
Right Heart ◽  
Heart Catheterisation ◽  
Right Heart Catheterisation ◽  
Pulmonary Arterial

Right heart catheterisation (RHC) plays a central role in identifying pulmonary hypertension (PH) disorders, and is required to definitively diagnose pulmonary arterial hypertension (PAH). Despite widespread acceptance, there is a lack of guidance regarding the best practice for performing RHC in clinical practice. In order to ensure the correct evaluation of haemodynamic parameters directly measured or calculated from RHC, attention should be drawn to standardising procedures such as the position of the pressure transducer and catheter balloon inflation volume. Measurement of pulmonary arterial wedge pressure, in particular, is vulnerable to over- or under-wedging, which can give rise to false readings. In turn, errors in RHC measurement and data interpretation can complicate the differentiation of PAH from other PH disorders and lead to misdiagnosis. In addition to diagnosis, the role of RHC in conjunction with noninvasive tests is widening rapidly to encompass monitoring of treatment response and establishing prognosis of patients diagnosed with PAH. However, further standardisation of RHC is warranted to ensure optimal use in routine clinical practice.

scholarly journals P1261DIAGNOSTIC VALUE OF TEMPORARY OCCLUSION OF ARTERIO-VENOUS HIGH FLOW FISTULA DURING RIGHT HEART CATHETERISATION IN PATIENTS WITH PULMONARY HYPERTENSION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Eugene Zeltyn-Abramov ◽  
RUSTAM ISKHAKOV ◽  
NATALYA BELAVINA ◽  
NATALIYA KLOCHKOVA ◽  
NADIA FROLOVA
Keyword(s):  
Arterial Pressure ◽  
Pulmonary Arterial Pressure ◽  
High Flow ◽  
Right Atrial ◽  
Volume Index ◽  
Atrial Volume ◽  
Right Heart ◽  
Systolic Pulmonary Arterial Pressure ◽  
Pulmonary Arterial

Abstract Background and Aims Pulmonary hypertension (PH) is prevalent in patients with functioning high-flow arterio-venous fistula (HFAVF) and associated with congestive heart failure (CHF). The real incidence and possible causes of this phenomenon is a matter of debate. Hemodynamic effects of HFAVF is considering as one of the reasons for PH formation. The subject of study was the impact of HFAVF on selected parameters of central hemodynamics. In particular, the diagnostic relevance of test of temporary HFAVF occlusion (TTO) was evaluated during right heart catheterization (RHC). Method A total of 13 patients were enrolled: 8 - after kidney transplantation (KT) with preserved allograft function and 5 - on maintenance hemodialysis (HD). All of them demonstrated clinical presentation of CHF III-IV class (NYHA). Severe PH and diastolic disfunction (DD) were observed at a baseline: echocardiographic systolic pulmonary arterial pressure sPAP (mmHg): M=59 (SD 13), ratio of mitral early diastolic inflow velocity (E) (pulsed wave Doppler) to average of septal and lateral mitral annular early-diastolic peak velocity (e′) (tissue Doppler imaging) E/e′ M=18 (SD 5). The ones who have comorbid conditions that cause PH were excluded. All patients bore an upper arm HFAVF, flow of the AVF (Qa) measured by Doppler ultrasonography was markedly high (Qa): M = 3,8 l/min (SD 1,2), the cardio-pulmonary recirculation (Qa/CO): M = 51% (SD 13). All patients underwent RHC and TTO AVF. Echocardiography (Echo) was performed initially and on the follow up (8 weeks after AVF closure/flow reduction). Statistical analysis was performed using the STATISTICA 13 software (Wilcoxon, T-test). Results The results of RHC and Echo data are presented in tables 1, 2. As can be seen from the table data, all cases demonstrated instrumental features of high output CHF (HO CHF) in accordance with patient’s clinical status. TTO of HFAVF resulted in statistically significant decrease in CO and CI values, but no changes in PAP parameters were observed. Taking into account clinical and instrumental features of advanced CHF, HF AVF was closed in 8 patients after KT and in 2 patients on HD. 3 patients on HD underwent AVF flow reduction up to Qa not exceeding 1,1 l/min. Follow-up demonstrated complete resolution of CHF and dramatic improvement of DD, reduction in CO, CI, sPAP, volume parameters. CO, cardiac output; CI, cardiac index; sPAP, systolic pulmonary arterial pressure; meanPAP, mean pulmonary arterial pressure; RAP, mean right atrial pressure; PCWP, pulmonary capillary wedge pressure; LV EDVi, left ventricular end-diastolic volume index; LAVi, left atrial volume index; RAVi, right atrial volume index; Conclusion PH is a component of AVF-induced HO CHF and could be classified as postcapillary one. TTO confirms significant HFAVF contribution to specific changes of parameters of central hemodynamics due to HO CHF. TTO does not impact on PAP values and therefore is not valid to clarify PH genesis per se.

scholarly journals Korelasi Forced Expiratory Volume in 1 Second % Prediksi dengan Tekanan Rerata Arteri Pulmonalis Menggunakan Ekokardiografi pada Penderita Penyakit Paru Obstruktif Kronik Stabil

2017 ◽  
Vol 3 (4) ◽  
pp. 177
Author(s):  
Munadi Munadi ◽  
M Yamin ◽  
Anna Ujainah ◽  
Cleopas Martin Rumende
Keyword(s):  
Pulmonary Hypertension ◽  
Arterial Pressure ◽  
Pulmonary Arterial Pressure ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Right Heart ◽  
Obstructive Pulmonary Disease ◽  
Mean Pulmonary Arterial Pressure ◽  
Copd Patients ◽  
Pulmonary Arterial

Pendahuluan. Hipertensi pulmonal merupakan komplikasi tersering pada penyakit paru obstruktif kronis (PPOK). Angka kematian akan meningkat tajam apabila pasien PPOK sudah mengalami komplikasi ini. Selama ini pengukuran tekanan arteri pulmonalis hanya diukur pada saat pasien PPOK eksaserbasi dirawat di ruang intesif dengan cara invasif menggunakan alat right heart catherization (RHC). Data kelompok PPOK stabil yang mengalami hipertensi pulmonal yang diukur dengan cara non invasif masih relatif sedikit yang dipublikasi. Saat ini sudah ada ekokardiografi yang dapat digunakan sebagai pengganti RHC pada kelompok PPOK stabil. Penelitian ini dilakukan untuk mengetahui apakah ada hubungan antara penurunan forced expiratory volume in 1 second (FEV1) % prediksi dengan peningkatan rerata tekanan arteri pulmonalis (mean pulmonary arterial pressure, mPAP) dan mencari titik potong terbaik secara klinis antara FEV1 % prediksi dan mPAP.Metode. Studi potong lintang pada lima puluh delapan subjek PPOK stabil yang dilakukan spirometri dan pengukuran mPAP dengan menggunakan ekokardiografi doppler pada potongan short axis setinggi aorta.Hasil. Nilai rerata FEV1 % prediksi 26,6 (SB 4,7) dan rerata mPAP 37,61 (18,1-59) mmHg. 74 % subjek mengalami hipertensi pulmonal, dengan karakteristik 24 % ringan, 31 % sedang dan 19 % berat. Terdapat korelasi negatif kuat antara penurunan FEV1 % prediksi dengan peningkatan mPAP. Semakin turun FEV1% prediksi semakin meningkat mPAP. Nilai titik potong terbaik secara klinis 55,3 % dengan sensitivitas 93%.Simpulan. FEV1 % prediksi berkorelasi negatif yang sangat kuat dengan tekanan rerata arteri pulmonalis. FEV1 % prediksi 55,3 % memiliki kemampuan yang cukup baik membedakan PPOK stabil yang sudah mengalami hipertensi pulmonal.Kata Kunci: ekokardiografi, FEV1 %, mPAP, PPOK stabil, spirometri  Correlation of Forced Expiratory Volume in 1 Second Prediction with Mean Pulmonary Arterial Pressure Using Echocardiography in Stable Chronic Obstructive Pulmonary Disease Introduction. Pulmonary hypertension is the most common complication of chronic obstructive pulmonary disease (COPD). Mortality rate will increase when COPD complication with pulmonary hypertension. Right heart catheterization (RHC) is the most common tool to measure mean pulmonary arterial pressure (mPAP) either in COPD patients with exacerbations treated in intensive care unit. Data of pulmonary hypertension in stable COPD group is still relatively rare. Alternatively to RHC, nowadays echocardiography is used to measure mean pulmonary arterial pressure in stable COPD group.Methods. A cross-sectional study was conducted on fifty-eight stable male COPD patients (mean age: 67,6) underwent spirometry. Mean pulmonary arterial pressure was measured using transthoracic echocardiography at short axis view in aortic level. Results. Mean value of forced expiratory volume in 1 second (FEV1)% was 26,6 % (SD 4,7) with median value of mean pulmonary arterial pressure was 37,61 mmHg (range 18,3-59). As many as 74% subjects were pulmonary hypertension; 24 % mild, 31 % moderate and 19% severe respectively. The correlation test showed a significant strong-negative correlation (r = -0,948, p <0,001). The best cut-off point of FEV1% prediction, which had a clinical value correlated with mPAP, was 55,3% with the sensitivity 93 %. Conclusions. Forced expiratory volume in one second (FEV1)% prediction has a significant correlation with mean pulmonary arterial pressure in stable COPD patients. The cut-off point FEV1% prediction 55,3% has a good capability to discriminate pulmonary hypertension in stable COPD patient. Keywords: echocardiography, FEV1% prediction, mean pulmonary arterial pressure, stable COPD

Abstract 15903: Pulmonary Arterial Pressure During Recovery From Exercise Predicts Outcomes in Patients Undergoing Evaluation for Dyspnea

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
David S Olshan ◽  
Rohan Bhat ◽  
Robyn Farrell ◽  
Mark Schoenike ◽  
Liana Brooks ◽  
...  
Keyword(s):  
Heart Failure ◽  
Arterial Pressure ◽  
Pulmonary Arterial Pressure ◽  
Peak Exercise ◽  
Event Free Survival ◽  
Free Survival ◽  
Heart Failure Event ◽  
Failure Event ◽  
Pulmonary Arterial ◽  
Hemodynamic Measurements

Introduction: The post-exercise recovery period poses advantages over the within-exercise period for acquisition of hemodynamic measurements because of attenuated respirophasic changes, ability to time measurements precisely relative to peak exercise, and increased feasibility of multi-modality data acquisition (i.e. echocardiographic imaging). While several studies have linked rest and exercise hemodynamic measurements to outcomes, the prognostic significance of recovery hemodynamics in patients with dyspnea on exertion remains unknown. Hypothesis: Impaired recovery of mean pulmonary arterial pressure (mPAP) following exercise predicts poor clinical outcomes. Methods: Upright incremental ramp cycle ergometry cardiopulmonary exercise testing with invasive hemodynamic monitoring was performed in patients referred for evaluation of exertional dyspnea. mPAP was obtained at rest, peak exercise, and at two-minutes following peak exercise. In addition, maximum workload was recorded for each patient. mPAP elevation at recovery versus baseline, indexed to peak workload, was determined. Cox regression was performed using the primary outcome of heart failure event-free survival. Results: Among 272 patients with dyspnea on exertion and preserved LVEF [age 61 (IQR 49 – 70), 47% male, BMI 29 kg/m 2 (25 – 34), exercise duration 8.1 minutes (6.9 – 9.2), peak workload 91 watts (71 – 121)] we observed an increase in mPAP from 17 (14– 20) to 33 (28 – 41) mmHg with a fall in mPAP to 22 (18 – 29) at 2 minutes of recovery. Median mPAP elevation at recovery versus baseline mPAP, indexed to peak workload, was 0.057 (0.031 – 0.101) mmHg/W. Persistently elevated mPAP, indexed to peak workload, was associated with future risk of HF hospitalization or death both in unadjusted analysis (Cox hazard ratio 1.53 for every standard deviation increase, p=0.003), and when adjusted for age, sex, and BMI (HR 1.40, p=0.025). Conclusions: Among patients with dyspnea on exertion undergoing invasive hemodynamic evaluation during exercise, persistently elevated mPAP following exercise predicts future heart failure event-free survival and may be more feasible to estimate non-invasively than measures obtained at peak exercise.

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