Right heart catheterization: Cardiac output, vascular resistance, shunt detection, and quantification

2017 ◽  
pp. 115-130
Author(s):  
Franz R. Eberli
Keyword(s):  
Cardiac Output ◽  
Vascular Resistance ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart ◽  
Detection And Quantification

Abstract 1597: Safety and Efficacy of Inhaled Iloprost Via a Disposable Nebulizer in Heart Failure Patients With Elevated Pulmonary Vascular Resistance

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
David Baran ◽  
Luis H Arroyo ◽  
Jill Hebron ◽  
Candace Carr ◽  
Mark J Zucker
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart ◽  
Heart Failure Patients ◽  
Inhaled Iloprost ◽  
The Mean

Background : Pulmonary vascular resistance (PVR) is routinely measured in patients (pts) being evaluated for a heart transplant. Pts with a high PVR are often treated with a milrinone or intravenous vasodilator “challenge” to establish that the PVR is not “fixed”. However, all current agents have dose-limiting side effects such as arrhythmias and hypotension. Inhaled iloprost would be an option but it is given with a costly adaptive aerosol delivery device. In addition, the efficacy and safety of this drug in left heart failure is poorly studied. Methods : 10 adult heart failure pts who were found to have a PVR of greater than 200 dyne-sec on routine right heart catheterization were enrolled. 50 micrograms (mcg) of iloprost was inhaled while in the catheterization laboratory using a disposable nebulizer and outflow filter, over 10 minutes. Hemodynamics were monitored at baseline, following drug inhalation, and 20 minutes later. Results : The average age of the patients (6 male, 4 female) was 64.8 ± 8.9 years. The mean left ventricular ejection fraction was 20.6 ± 8.6 %. The mean creatinine clearance (Cockroft-Gault) was 48.7 ± 18.9 ml/hr. The mean arterial pressure (MAP), pulmonary artery systolic (PAS), PA diastolic (PAD), PCWP, transpulmonic gradient (TPG), cardiac output (CO), and PVR at baseline, 10 minutes and 20 minutes post-inhalation are detailed below. Iloprost significantly reduced PAS, TPG and PVR without changes in MAP, PAD, PCWP or CO. These effects remained significant at study completion as well. There were no adverse events noted. Conclusion : Iloprost inhalation was well tolerated in heart failure patients undergoing right heart catheterization. Inhalation of 50 mcg of iloprost via a simple hospital nebulizer was associated with safe, rapid, and significant declines in indices of pulmonary vascular tone, without affecting cardiac output or PCWP. Further investigation of this novel use of iloprost is warranted. Results

High Cardiac Output By Microfistulas: A New Pulmonary Hypertension Mechanism in Patients with Myelofibrosis and the Impact of the Treatment with Ruxolitinib

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4065-4065
Author(s):  
Jose Maria Segovia ◽  
Emilio Ojeda ◽  
Gomez-Bueno Manuel Francisco ◽  
Rafael Fores ◽  
Jose A Garcia-Marco ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Output ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart ◽  
High Cardiac Output ◽  
Advanced Phase ◽  
The Impact

Abstract Background: Pulmonary Hypertension (PH) is a well-known complication of the advanced phase of Myeloproliferative Diseases (MPD) such as Polycythemia Vera (PV), Essential Thrombocytopenia (ET) and Myelofibrosis (MF). Although initially attributed to increased pulmonary vascular resistance (group 1 PH of the WHO classification), this entity was classified in 2009 in group 5 PH (unknown mechanism and miscellaneous PH). Our aim was to describe the prevalence and possible causes of PH in a series of patients with MF. Methods: We studied a series of patients with Primary MF or Secondary MF to other MPD with cardiac ultrasound, right heart catheterization and scintigraphy after intraarterial infusion of Tc99-labeled albumin macroaggregates. Results: We studied 11 consecutive patients with MF (7 male, mean age 58 years, 4 with MF post-PV, 4 post-TE and 3 Primary MF) during the period 2009-2014. All of them had mutations of JAK-2 gene, fibrosis in bone marrow biopsy and visceromegaly (all with intermediate-2 or higher IPSS). Median NTproBNP levels were 4597 pg/ml (range 175-5700). Echocardiogram showed high systolic pulmonary pressure in most cases, with a mean of 54 ± 17 mmHg (range 35-80). Right heart catheterization showed high cardiac output (HCO) in all patients (table 1). After ruling out other causes of HCO, a scintigraphy was performed after administration of Tc99-labeled albumin macroaggregates in descending thoracic aorta. In every case, a percentage of the labeled macroaggregates (6.1 ± 2.0% of the radioactivity) were plugged in the pulmonary capillary bed, what is diagnostic of the presence of microfistulas in infradiaphragmatic territory. In two of these patients, scintigraphies were performed at diagnosis and after been treated with the anti-JAK drug Ruxolitinib (Novartis Pharma). A favourable impact of this drug was obtained in the two cases, probably due to a reduction of spleen volume. Conclusion: Most patients with MF show pulmonary hypertension associated with high cardiac output caused by microfistulas, without significant increase in pulmonary resistance. This finding has important clinical implications, because pulmonary vasodilators (once recommended) should be contraindicated, since they could cause worsening of the clinical picture. Ruxolitinib could resolve PH in MF and a prospective study in this sense could be indicated. Table 1. Patient 1 2 3 4 5 6 7 8 9 10 11 Pulmonary Artery Pres. (S/D/Mean) 58/38/ 42 69/41/ 50 48/29/ 40 84/26/ 45 57/17/ 30 22/17 / 19 51/16 / 28 22/9 / 13 25/8 / 14 71/23 / 39 30/7 / 15 Pulmonary wedge pres. 28 37 27 13 9 7 13 7 8 12 6 Cardiac output (l/min) 12.5 8.0 11 7.1 8 7.3 8.7 6.7 7.45 6 7.8 Cardiac index (l/m/m2) 5.5 4.0 6.6 3.6 5 4 4.8 4.0 4.5 3.9 5.1 Pulmonary vascular resistance (Wood U.) 1.2 1.4 1.2 4.5 2.6 3 1.7 0.9 0.8 4.5 1.1 Disclosures Ojeda: Alexion Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Fores:Alexion Pharmaceuticals: Consultancy, Speakers Bureau.

scholarly journals Diagnostic value of right heart and pulmonary artery catheterization in patients with suspected pulmonary hypertension. Part 1. Methodology of the procedure, nosology of the diseases and vasoreactivity testing

2020 ◽  
Vol 26 (6) ◽  
pp. 64-76
Author(s):  
Yu. M. Sirenko ◽  
I. O. Zhyvylo ◽  
G. D. Radchenko
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Index ◽  
Pulmonary Artery ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Pulmonary Artery Catheterization ◽  
Right Heart ◽  
The Mean

The aim – critical review of our own experience, its compliance with current recommendations and data from international registries, as also assessment of pulmonary and systemic hemodynamics obtained in patients with pulmonary arterial hypertension (PAH) in Ukraine. Materials and methods. 220 procedures of the right heart and pulmonary artery catheterization were performed in 195 patients with medium or high probability of PAH according to echocardiography in compliance with current recommendations. All patients were hospitalized at National Scientific Center “M.D. Strazhesko Institute of Cardiology” of NAMS of Ukraine with suspected PAH (primary) or with worsening of the disease course (repeatedly) or in order to confirm the status of vasoreactivity (repeated).Results and discussion. 220 successful catheterization procedures were performed. Primary (diagnostic) right heart catheterization was performed in 195 patients, and repeated – in 25. A diagnosis of pulmonary hypertension was confirmed in 178 patients. In 17 patients, according to the results of catheterization, the diagnosis of PAH was excluded: the mean pressure in the pulmonary artery was less than 20 mm Hg. The structure of nosology in patients who underwent right heart catheterization was as follows: idiopathic PAH was fixed in 68 (38 %) patients, of which 11 (6 %) were vasoreactive; PAH associated with connective tissue diseases – in 21 (12 %) patients; PAH associated with HIV infection in – 4 (2 %) patients; PAH associated with portal hypertension – in 4 (2 %) patients; PAH associated with congenital heart disease – in 26 (15 %) patients; chronic thromboembolic pulmonary hypertension – in 50 (28 %) patients. Vasoreactivity testing was performed in 33 patients with idiopathic PAH. In 11 of them it was positive (33 %). In patients with a positive vasoreactivity testing, the mean pulmonary artery pressure decreased by an average of 21.8 mm Hg to the level of 26.5 mm Hg (p 0.0001), while the cardiac index increased by 31 % and reached 3.8 l · min · m–2 (p<0.1). Pulmonary vascular resistance decreased by 6.4 Wood units to the level of 2.7 Wood units (p<0.0001). In patients with a negative vasoreactivity testing, the decrease in mean pulmonary artery pressure and pulmonary vascular resistance was not statistically significant (p>0.05), and no changes in the cardiac index were detected. Conclusions. Based on the experience of our center, hemodynamic assessment using catheterization is safe and remains the diagnostic standard for PAH. Catheterization is necessary to clarify 4 parameters that are critical for the clinical profile of patients with pulmonary hypertension: right atrium pressure, pulmonary vascular resistance, cardiac output, pulmonary wedge pressure. Patients with idiopathic PAH also need to have vasoreactivity evaluated in order to predict sensitivity to calcium channel blockers therapy, the presence of which is associated with better treatment and survival outcomes.

scholarly journals Right Atrial Pressure During Exercise Predicts Survival in Patients With Pulmonary Hypertension

2020 ◽  
Vol 9 (22) ◽  
Author(s):  
Mona Lichtblau ◽  
Patrick R. Bader ◽  
Stéphanie Saxer ◽  
Charlotte Berlier ◽  
Esther I. Schwarz ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Output ◽  
Right Heart Catheterization ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Heart Catheterization ◽  
Right Heart ◽  
Risk Of Death ◽  
Exercise Induced

Background We investigated changes in right atrial pressure (RAP) during exercise and their prognostic significance in patients assessed for pulmonary hypertension (PH). Methods and Results Consecutive right heart catheterization data, including RAP recorded during supine, stepwise cycle exercise in 270 patients evaluated for PH, were analyzed retrospectively and compared among groups of patients with PH (mean pulmonary artery pressure [mPAP] ≥25 mm Hg), exercise‐induced PH (exPH; resting mPAP <25 mm Hg, exercise mPAP >30 mm Hg, and mPAP/cardiac output >3 Wood Units (WU)), and without PH (noPH). We investigated RAP changes during exercise and survival over a median (quartiles) observation period of 3.7 (2.8–5.6) years. In 152 patients with PH, 58 with exPH, and 60 with noPH, median (quartiles) resting RAP was 8 (6–11), 6 (4–8), and 6 (4–8) mm Hg ( P <0.005 for noPH and exPH versus PH). Corresponding peak changes (95% CI) in RAP during exercise were 5 (4–6), 3 (2–4), and −1 (−2 to 0) mm Hg (noPH versus PH P <0.001, noPH versus exPH P =0.027). RAP increase during exercise correlated with mPAP/cardiac output increase ( r =0.528, P <0.001). The risk of death or lung transplantation was higher in patients with exercise‐induced RAP increase (hazard ratio, 4.24; 95% CI, 1.69–10.64; P =0.002) compared with patients with unaltered or decreasing RAP during exercise. Conclusions In patients evaluated for PH, RAP during exercise should not be assumed as constant. RAP increase during exercise, as observed in exPH and PH, reflects hemodynamic impairment and poor prognosis. Therefore, our data suggest that changes in RAP during exercise right heart catheterization are clinically important indexes of the cardiovascular function.

Abstract 15302: Cardiac MRI Assessment of Cardiac Output Agrees With Simultaneous Fick Assessment in Pediatric Heart Transplant Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jennifer Schramm ◽  
Ileen Cronin ◽  
Robert McCarter ◽  
Russell Cross ◽  
joshua kanter ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Heart Transplant ◽  
Phase Contrast ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Limits Of Agreement ◽  
Right Heart ◽  
Transplant Patients ◽  
Pediatric Heart Transplant ◽  
Good Agreement

Introduction: Systemic cardiac output (Qs) and pulmonary blood flow (Qp) can be measured by cardiac magnetic resonance (CMR) and invasive oximetry, with studies showing good agreement between the two modalities. CMR-guided right heart catheterization (MR-RHC) collects simultaneous CMR and oximetry measurements permitting direct comparison. This study assessed agreement between CMR and Fick measurements of cardiac output in the pediatric heart transplant (HT) population. Methods: Twenty-three pediatric HT patients (body surface area range 0.6-2 m 2 ) with 53 MR-RHC between 2014 -2020 were reviewed. One outlier was excluded due to erroneous pulmonary vein saturation, leaving 52 MR-RHC for analysis. Measurements of un-indexed Qs and Qp from both CMR phase contrast and invasive oximetry using Fick were collected. Bland-Altman (BA) statistical and graphical analyses compared CMR versus Fick estimates of Qs and Qp. Results: BA limits of agreement (LOA) and corresponding concordance plot demonstrate good agreement between CMR and Fick (Figure 1). Panels A and B are the BA and concordance plots for Qs, respectively. Panels C and D are the BA and concordance plots for Qp, respectively. The 95% confidence interval LOA are -1.0 to +1.8 for Qs and -1.0 to +1.7 for Qp. Average bias and Lin correlation are similar for Qs and Qp at +0.36 L/min and 0.8, respectively. Conclusions: CMR and Fick measurements of Qs and Qp are similar in pediatric HT patients, with a tendency for slightly higher values by Fick estimates and similar LOA to previously published results. CMR acquired hemodynamics offer a radiation-free modality to reduce overall radiation exposure for pediatric HT patients.

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