Role of Pulmonary Artery Wedge Pressure Saturation During Right Heart Catheterization

Background Resting right heart catheterization can assess both left heart filling and pulmonary artery (PA) pressures to identify and classify pulmonary hypertension. Although exercise may further elucidate hemodynamic abnormalities, current pulmonary hypertension classifications do not consider the expected interrelationship between PA and left heart filling pressures. This study explored the utility of this relationship to enhance the classification of exercise hemodynamic phenotypes in pulmonary hypertension. Methods and Results Data from 36 healthy individuals (55, 50–60 years, 50% male) and 85 consecutive patients (60, 49–71 years, 48% male) with dyspnea and/or suspected pulmonary hypertension of uncertain etiology were analyzed. Right heart catheterization was performed at rest and during semiupright submaximal cycling. To classify exercise phenotypes in patients, upper 95% CIs were identified from the healthy individuals for the change from rest to exercise in mean PA pressure over cardiac output (ΔmPAP/ΔCO ≤3.2 Wood units [WU]), pulmonary artery wedge pressure over CO (ΔPAWP/ΔCO ≤2 mm Hg/L per minute), and exercise PA pulse pressure over PAWP (PP/PAWP ≤2.5). Among patients with a ΔmPAP/ΔCO ≤3.2 WU, the majority (84%) demonstrated a ΔPAWP/ΔCO ≤2 mm Hg/L per minute, yet 23% demonstrated an exercise PP/PAWP >2.5. Among patients with a ΔmPAP/ΔCO >3.2 WU, 37% had an exercise PP/PAWP >2.5 split between ΔPAWP/ΔCO groups. Patients with normal hemodynamic classification declined from 52% at rest to 36% with exercise. Conclusions The addition of PP/PAWP to classify exercise hemodynamics uncovers previously unrecognized abnormal phenotypes within each ΔmPAP/ΔCO group. Our study refines abnormal exercise hemodynamic phenotypes based on an understanding of the interrelationship between PA and left heart filling pressures.

Download Full-text

Pulmonary hypertension

10.1093/med/9780199568741.003.0100 ◽

2018 ◽

Author(s):

Robert MacKenzie-Ross ◽

Karen K. K. Sheares ◽

Joanna Pepke-Zaba

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Pulmonary Capillary Wedge Pressure ◽

Pressure Measurement ◽

Right Heart Catheterization ◽

Heart Catheterization ◽

Right Heart ◽

Pulmonary Capillary ◽

Pathophysiological Condition ◽

Wedge Pressure

Pulmonary hypertension (PH) is a haemodynamic and pathophysiological condition defined as mean pulmonary artery pressure ≥25 mm Hg at rest, assessed by right-heart catheterization (8–20 mm Hg is considered normal). A pulmonary capillary wedge pressure measurement of >15 mm Hg indicates a significant pulmonary venous component. PH is associated with a variety of causes. The current PH classification is helpful in understanding the different etiological, pathological, and treatment approaches.

Download Full-text

Comparison of Pulmonary Artery Pressure Measurement With Doppler Echocardiography or With Right Heart Catheterization in Patients With Congenital Heart Disease

Frontiers in Pediatrics ◽

10.3389/fped.2019.00421 ◽

2019 ◽

Vol 7 ◽

Author(s):

Dan Yin ◽

Ying Wang ◽

Min Zheng ◽

Huijing Wei ◽

Mi Li ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Doppler Echocardiography ◽

Pressure Measurement ◽

Congenital Heart ◽

Right Heart Catheterization ◽

Heart Catheterization ◽

Right Heart

Download Full-text

Effect of abnormal right heart structures on the diagnosis of pulmonary hypertension

Pulmonary Circulation ◽

10.1177/2045894018773053 ◽

2018 ◽

Vol 8 (2) ◽

pp. 204589401877305 ◽

Cited By ~ 1

Author(s):

Batool AbuHalimeh ◽

Milind Y. Desai ◽

Adriano R. Tonelli

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Right Heart Catheterization ◽

The Other ◽

Heart Catheterization ◽

Right Heart ◽

Cardiac Lesions ◽

The Right ◽

The Impact ◽

Heart Lesions

The diagnosis of pulmonary hypertension (PH) requires a right heart catheterization (RHC) that reveals a mean pulmonary artery pressure ≥ 25 mmHg. The pulmonary artery catheter traverse the right atrium and ventricle on its way to the pulmonary artery. The presence of abnormal right heart structures, i.e. thrombus, vegetation, benign or malignant cardiac lesions, can lead to complications during this procedure. On the other hand, avoidance of RHC delays the diagnosis and treatment of PH, an approach that might be associated with worse outcomes. This paper discusses the impact of right heart lesions on the diagnosis of PH and suggests an approach on how to manage this association.

Download Full-text

Abstract 17141: Pulmonary Artery Pulsatility Index is Associated With Greater Mortality Across a Broad Hospital-Based Cohort

Circulation ◽

10.1161/circ.142.suppl_3.17141 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Emily K Zern ◽

Paula Rambarat ◽

Samantha Paniagua ◽

Elizabeth Liu ◽

Jenna McNeill ◽

...

Keyword(s):

Myocardial Infarction ◽

Pulmonary Artery ◽

Pulsatility Index ◽

Right Heart Catheterization ◽

Left Ventricular ◽

Right Atrial ◽

Heart Catheterization ◽

Right Heart ◽

Risk Of Death ◽

Valvular Surgery

Introduction: The pulmonary artery pulsatility index (PAPi), calculated from the ratio of pulmonary artery pulse pressure to right atrial pressure, was initially described as a novel predictor of right ventricular failure after inferior myocardial infarction or left ventricular assist device implantation. Whether PAPi is associated with adverse outcomes in broader samples is unknown. Hypothesis: A lower PAPi is associated with mortality in a broad population referred for right heart catheterization. Methods: We examined consecutive patients undergoing right heart catheterization between 2005-2016 in a hospital-based cohort. The following exclusion criteria were applied: shock or cardiac arrest within 24 hours of catheterization, presence of mechanical circulatory support, prior cardiac transplant, prior valvular surgery, or those with missing key clinical covariates. Multivariable Cox models were utilized to examine the association between PAPi and mortality. Analyses were adjusted for age, sex, BMI, hypertension, diabetes, prior myocardial infarction, and prior heart failure. Results: We studied 8559 patients with mean age 63 years and 40% women. We found that patients in the lowest quartile of PAPi were younger, with greater proportion of men, and higher BMI, yet similar NT-proBNP compared with other quartiles ( Table 1 ). Over 12.5 years of follow-up, there were 2441 death events. Patients in the lowest PAPi quartile had a 31% greater risk of death compared with the highest quartile (multivariable adjusted HR 1.31, 95% CI 1.15-1.48, p<0.001), whereas no differences in survival were seen among individuals in quartile 2 or 3 (p>0.05 vs quartile 4 for both). Conclusions: Patients in the lowest PAPi quartile had a 31% increased risk of all-cause mortality in a broad population referred for right heart catheterization. These findings highlight a potential role for PAPi in identifying high-risk individuals across a spectrum of disease.

Download Full-text

P1529 Impact of the new PH guidelines on echocardiographic definition leading to double demand of right heart catheterization

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.951 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

C Fauvel ◽

O Raitiere ◽

J Burdeau ◽

N Si Belkacem ◽

F Bauer

Keyword(s):

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Tricuspid Regurgitation ◽

Peak Velocity ◽

Right Heart Catheterization ◽

Heart Catheterization ◽

Right Heart ◽

Artery Pressure ◽

Mean Pulmonary Artery Pressure ◽

Definition Of

Abstract Background Doppler echocardiography is the most widespread and well-recognized technique for the screening of patients with pulmonary hypertension (PH). When tricuspid regurgitation peak velocity (TRPV) ≥3.4 m/s, right heart catheterization is requested to confirm mean pulmonary artery pressure >25 mm Hg. In the proceedings from the 6th world symposium on pulmonary arterial hypertension recently released, the new definition of PH has been lowered to mean pulmonary artery pressure > 20 mm Hg. Purpose The purpose of our work was twofold : i) to determine a new cut-off value for TRPV to accommodate the new hemodynamic definition of PH, ii) to investigate the impact on the demand of right heart catheterization (RHC) from our echo CORE lab. Methods We extracted and analyzed both the haemodynamic and echocardiographic records of 130 patients who underwent investigations the same day. Tricuspid regurgitation peak velocity was measured in apical-4 chamber view using continuous-wave doppler modality and compared to mean pulmonary artery pressure recorded from fluid-filled catheter. Results Tricuspid regurgitation peak velocity has a weak correlation with mean pulmonary pressure (y = 9.2x-2.2, r² = 0.22, p < 0.01). Targeting a mean pulmonary pressure on right heart catheterization of 20 mm Hg for the definition of PH, receiver operating characteristic curve analysis demonstrated a good association between TRPV and PH diagnosis (area under the curve, 0.78 ; p < 0.001). The cut-off value obtained for TRPV was 3.0 m/s (Se = 0.78, Sp = 0.37). From 01/01/18 to 31/12/18, 2539 out of 6215 had TRPV recorded from which 283 had TRPV ≥ 3.0 m/s (24,1%) and 615 had TRPV ≥ 3.4 m/s (11,1%). When applied to a community population the new TRPV cutoff > 3m/s used as surrogate for mean pulmonary artery pressure > 20 mm Hg may produce a 111% increase of right heart catheterization demand. Conclusions The new definition of pulmonary hypertension (invasive mean pulmonary artery pressure > 20mm Hg) necessitates revisiting tricuspid regurgitation peak velocity > 3 m/s as a screening test leading to more than twice RHC demand.

Download Full-text