Pulmonary Hypertension

Pulmonary Capillary ◽

Initial Work ◽

The Right ◽

Work Up ◽

Pulmonary hypertension (PH) is defined as a pulmonary capillary wedge pressure >25 mm Hg. Patients tend to present with nonspecific symptoms centered on worsening dyspnea. The causes of PH are classified according to the Dana Point classification which groups causes of PH based on shared pathophysiology and treatments. In the initial work up of patients with PH, the goal of imaging is determine if there are findings of PH and to look for clues to the underlying cause so that patients are treated appropriately. MRI can be useful in the follow up of patients with PH, as it can evaluate for changes in the right ventricle.

Faculty Opinions recommendation of Prognostic value of the pre-transplant diastolic pulmonary artery pressure-to-pulmonary capillary wedge pressure gradient in cardiac transplant recipients with pulmonary hypertension.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718417343.793502538 ◽

2014 ◽

Author(s):

Jean-Luc Vachiery

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Pressure Gradient ◽

Pulmonary Artery Pressure ◽

Prognostic Value ◽

Cardiac Transplant ◽

Transplant Recipients ◽

Pulmonary Capillary ◽

Abstract 2693: Mitral E/E’ underestimates Pulmonary Capillary Wedge Pressure During Exercise.

Circulation ◽

10.1161/circ.116.suppl_16.ii_597-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Sébastien Marchandise ◽

Anne-Marie D’Hondt ◽

Olivier Gurne ◽

David Vancraeynest ◽

Bernhard Gerber ◽

...

Keyword(s):

Right Heart Catheterization ◽

Exercise Heart Rate ◽

Heart Catheterization ◽

Limited Data ◽

Pulmonary Capillary ◽

Lateral Decubitus ◽

The Right ◽

The Relationship ◽

Background. Previous studies have shown that resting LV filling pressures can be estimated noninvasively by use of the ratio of the early diastolic transmitral filling velocity (E) to the early diastolic septal tissue velocity (E’). Yet, limited data exist regarding the accuracy of this measurement during exercise. In this study, we therefore sought to evaluate the possible value of exercise E/E’ for predicting invasively measured pulmonary capillary wedge pressure (PCWP). Methods. 22 patients (57 ± 15 years, 10 males) with heart failure (n=14), valve disease (n=6) or pulmonary hypertension (n=2) underwent right heart catheterization during symptom limited bicycle exercise. For each patient, PCWP and Doppler measurements of E/E’ were acquired in left lateral decubitus, after 5 min of sitting and during the last minute of each exercise stage. Results. With exercise, heart rate increased from 78 ± 17 bpm to 118 ± 21 bpm, as did systolic blood pressure (from 128 ± 29 to 169 ± 30 mmHg, p<0.001), PCWP (from 15 ± 6 to 24 ± 9 mmHg, p<0.001), E velocity (from 84 ± 34 to 111 ± 41 cm.s -1 p<0.001) and septal E’ (from 6.2 ± 2.7 to 9.0 ± 4.3 cm.s -1 p<0.01). At rest, in both recumbent and sitting positions, E/E’ correlated well with PCWP (solid circle, y = 0.7856 X + 4.2084, r = 0.72). During exercise, E/E’ also correlated with PCWP (open circle, y = 0.5253x + 1.7168, r = 0.64). The relationship was nonetheless shifted downward and to the right compared to rest. Conclusion. While E/E’ correlates with PCPW both at rest and during exercise, the relationship between these 2 parameters is different under these 2 conditions. Therefore, E/E’ values defining elevated LV filling pressures at rest cannot be used during exercise.

Reliability of measurements of pulmonary artery pressure obtained with patients in the 60 degrees lateral position

American Journal of Critical Care ◽

10.4037/ajcc2000.9.1.43 ◽

2000 ◽

Vol 9 (1) ◽

pp. 43-51 ◽

Cited By ~ 5

Author(s):

LM Aitken

Keyword(s):

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

General Medicine ◽

Lateral Position ◽

Artery Pressure ◽

Pulmonary Capillary ◽

Quasi Experimental ◽

The Right ◽

BACKGROUND: Monitoring of pulmonary artery pressure is an essential component of the care of critically ill patients. The conditions under which reliable measurements can be obtained must be clarified. OBJECTIVES: To determine (1) whether reliable measurements of pulmonary artery pressure can be obtained with patients in the right or left 60 degrees lateral position and (2) which characteristics of patients preclude obtaining reliable measurements. METHODS: One hundred five patients (65 cardiac surgery, 40 general medicine) with pulmonary artery catheters were enrolled in a prospective, stratified, quasi-experimental study. Subjects were repositioned from supine (head of bed elevated < 30 degrees with 1 pillow) to the left and right 60 degrees lateral positions. Systolic, diastolic, and mean pulmonary artery pressures and pulmonary capillary wedge pressure were measured before and 5, 10, and 20 minutes after lateral repositioning. The zero reference was the phlebostatic axis when patients were supine and the dependent midclavicular line at the level of the fourth intercostal space when patients were in the lateral positions. RESULTS: In most patients, measurements obtained with patients in the lateral position differed significantly from measurements obtained with patients supine. None of the variables examined were reliable predictors of which patients would have these differences. More than 11% of the patients had clinically significant differences in addition to the statistically significant differences. CONCLUSION: Reliable measurements of pulmonary artery pressure and pulmonary capillary wedge pressure cannot be obtained with patients in the 60 degrees lateral position.