SAT0296 European Society of Cardiology/European Respiratory Society Guidelines and Detect Algorithm Right Heart Catheterisation Recommendations: A Real-Life Comparison: Table 1

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.

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Abstract 14268: Responses to Exercise During Right Heart Catheterisation in Pulmonary Hypertension

Circulation ◽

10.1161/circ.142.suppl_3.14268 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Stephanie Wiltshire ◽

Katherine Kearney ◽

Karen Brown ◽

Carolyn Corrigan ◽

Annette Pidoux ◽

...

Keyword(s):

Pulmonary Artery ◽

Statistical Significance ◽

Peripheral Resistance ◽

Hemodynamic Response ◽

Stroke Work ◽

Hemodynamic Changes ◽

Right Heart ◽

Heart Catheterisation ◽

Right Heart Catheterisation ◽

Response To Exercise

Background: Hemodynamic changes during exercise at right heart catheterisation (RHC) may be a diagnostic and prognostic tool in pulmonary arterial hypertension (PAH). Method and Results: We retrospectively assessed the hemodynamic response to exercise during RHC of 138 patients with PAH secondary to idiopathic PAH (IPAH), connective tissue disease (CTD) or congenital heart disease (CHD). RHCs were performed at a single centre between 2007 and 2018. A submaximal comfort-based protocol on a reclined bicycle or straight leg raise test (SLRT) was employed. IPAH demonstrated the highest mean pulmonary artery pressure (mPAP) at rest, rising 47% with exercise, but a 66% rise in CO allowed pulmonary vascular resistance (PVR) to fall. Those with CTD demonstrated a 56% rise in mPAP, 70% rise in CO and PVR remained unchanged. In CHD, there was a 46% rise in mPAP, 49% rise in CO and a rise in PVR. Notably, there was a rise in pulmonary artery wedge pressure (PAWP) in all groups, most marked in those with IPAH. Total peripheral resistance (TPR), pulmonary artery compliance (PAC) and pulmonary artery elastance (Ea) changes were variable. TPR marginally decreased in IPAH patients, remained unchanged in those with CTD and increased in CHD. PAC decreased in all groups, with the lowest values observed in those with IPAH. Ea increased in all groups but was most notably higher in those with IPAH. Right ventricular stroke work index (RVSWI) increased in all patients, the lowest values before and after exercise were observed in the CTD cohort. Mean pulmonary artery pulsatility index (PaPi) increased in all groups, although was subtle and didn’t meet statistical significance for those with CTD and CHD. Conclusions: The hemodynamic response to exercise in patients with PAH differs between aetiologies. A rise in PAWP occurred in all groups, with ventricular interdependence a possible explanation. Whether there is a relationship between exercise hemodynamic changes and prognosis remains undetermined.

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P4689How is the impact of updated hemodynamic definitions on frequencies of overall pulmonary hypertension and pre-capillary pulmonary hypertension as compared to those with previous criteria

European Heart Journal ◽

10.1093/eurheartj/ehz745.1070 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Tanyeri ◽

B Keskin ◽

O Y Akbal ◽

A Hakgor ◽

A Karagoz ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Critical Role ◽

Right Heart ◽

Right Heart Catheterisation ◽

Mean Pressure ◽

Pulmonary Arterial ◽

European Society Of Cardiology ◽

The Impact ◽

Wedge Pressure

Abstract Background and aim In this study we evaluated the impact of the updated pulmonary hypertension (PH) definitive criteria proposed in 6th World PH Symposium (WSPH) on numbers and frequencies of and pre- versus post-capillary PH as compared to those in European Society of Cardiology (ESC) 2015 PH Guidelines. Methods Study group comprised the retrospectively evaluated 1299 patients (pts) (age 53.1±18.8 years, female 807, 62.1%) who underwent right heart catheterisation (RHC) with different indications between 2006 and 2018. For ESC and WSPH PH definitions, pulmonary arterial mean pressure (PAMP) ≥25 mmHg (definition-A) and PAMP >20 mmHg (definition-B) RHC criteria were used, respectively. For pre-capillary PH definitions, pulmonary artery wedge pressure (PAWP) ≤15 mmHg and pulmonary vascular resistance (PVR) ≥3 Wood units criteria were included in the both definitions. Results In RHC assessments, PAMP ≥25 mmHg and >20 mmHg were noted in 891 (68.6%) and 1051 (80.9%) of overall pts, respectively. Moreover, pre-capillary PH was diagnosed in 284 (21.8%) and 298 (22.9%) with definition-A and B, respectively. Although updated WSPH definition was associated with a net 12.3% and a relative 18% increase in the overall PH diagnosis, net and relative changes in the frequency of the pre-capillary PH were only 1% and 4.9%. Increase in the overall PH with updated WSPH criterias compared to previous ESC definitions was associated with increase in the number of pre-capillary PH (n=298, 22.9%) but not in the overall frequency of post-capillary PH (688, 52.9%). Because PVR was the product of the transpulmonary gradient (PAMP minus PAWP) divided by cardiac output, this measure was found to keep specificity for distinction between pre- versus post-capillary PH even after lowering thetreshold diagnostic for PAMP from 25 to 20 mmHg. Conclusions Although updated WSPH definition was associated with net 12.3% and relative 18% increase in the overall PH diagnosis, its impact on frequencies of pre- versus post-capillary PH within overall PH population was negligible.These seem to be due to critical role of PVR ensuring specificity in pre-capillary PH diagnosis even after lowering the definitive PAMP treshold to 20 mmHg.

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Exercise right heart catheterisation before and after pulmonary endarterectomy in patients with chronic thromboembolic disease

European Respiratory Journal ◽

10.1183/13993003.00458-2018 ◽

2018 ◽

Vol 52 (3) ◽

pp. 1800458 ◽

Cited By ~ 10

Author(s):

Stefan Guth ◽

Christoph B. Wiedenroth ◽

Andreas Rieth ◽

Manuel J. Richter ◽

Ekkehard Gruenig ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Thromboembolic Disease ◽

Pulmonary Endarterectomy ◽

Right Heart ◽

Heart Catheterisation ◽

Right Heart Catheterisation ◽

Before And After ◽

The Mean ◽

Chronic Thromboembolic Disease ◽

The Impact

Symptomatic patients with chronic thromboembolic disease (CTED) without pulmonary hypertension often show an excessive increase in mean pulmonary arterial pressure (MPAP) during exercise.We report on the impact of pulmonary endarterectomy (PEA) on pulmonary haemodynamics in a prospective series of 32 consecutive CTED patients who underwent PEA. All patients had a comprehensive diagnostic work-up including right heart catheterisation at baseline and 12 months after PEA. Furthermore, in 12 patients exercise right heart catheterisation was performed before and after PEA.After PEA, MPAP was lower at rest (20±3 versus 17±3 mmHg; p=0.008) and during maximal exercise (39±8 versus 31±6 mmHg; p=0.016). The mean total pulmonary resistance (TPR) decreased from 3.6±0.8 Wood Units (WU) pre-operatively to 2.7±0.7 WU 1 year after PEA (p=0.004) and the mean slope of the MPAP/cardiac output (CO) relationship decreased from 3.6±1.0 to 2.3±0.8 WU (p=0.002). Peak oxygen uptake increased from 1.2±0.4 to 1.5±0.3 L·min−1 (p=0.014) and ventilatory equivalents of carbon dioxide decreased from 39±2 to 30±2 (p=0.002). There was a significant improvement in quality of life assessed by the Cambridge Pulmonary Hypertension Outcome Review questionnaire.In CTED patients, PEA resulted in haemodynamic and clinical improvements. The means of TPR and MPAP/CO slopes decreased to <3.0 WU.

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Dart to the target: an alternative bull’s eye parametric display for European Society of Cardiology / European Respiratory Society goal-orientated risk reduction strategy in pulmonary arterial hypertension

Pulmonary Circulation ◽

10.1177/2045894018780522 ◽

2018 ◽

Vol 8 (3) ◽

pp. 204589401878052

Author(s):

Cihangir Kaymaz ◽

Ozgur Yasar Akbal ◽

Aykun Hakgor ◽

Hacer Ceren Tokgoz ◽

Seda Tanyeri

Keyword(s):

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Risk Reduction ◽

European Society ◽

European Respiratory Society ◽

Reduction Strategy ◽

Risk Reduction Strategy ◽

Pulmonary Arterial ◽

European Society Of Cardiology ◽

Bull's Eye

Despite the significant mortality and mobidity benefits being obtained with the targeted therapies in patients with pulmonary arterial hypertension (PAH), mid- to long-term survival of patients with this disease has remained unsatisfactory. For earlier and reliable risk stratification in PAH and tailoring the dynamic management strategies, various risk assessment models have been developed. Currently available risk reduction strategy recommended by the European Society of Cardiology (ESC)/European Respiratory Society (ERS) 2015 Pulmonary Hypertension Guidelines has been utilized in three recent registries. In this review, we evaluated the risk prediction models and management algorithms in this setting and propose an alternative parametric display, a bull’s eye, dart table scheme for ESC/ERS goal-orientated risk reduction strategy in patients with PAH.

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Conclusion

10.1093/med/9780198784906.003.0604 ◽

2018 ◽

Author(s):

Marc Humbert

Keyword(s):

Pulmonary Hypertension ◽

European Society ◽

Hypertension Management ◽

Evidence Based ◽

European Respiratory Society ◽

Fast Growing ◽

Recent Advances ◽

European Society Of Cardiology ◽

Future Work

Pulmonary hypertension is a fast-growing field in cardiopulmonary medicine. Thanks to recent advances summarized in the 2015 European Society of Cardiology/European Respiratory Society guidelines, evidence-based pulmonary hypertension management can now be provided to all pulmonary hypertension patients. There are, however, important gaps of evidence which should be clarified in future work.

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