Usefulness of pulmonary capillary wedge pressure as a correlate of left ventricular filling pressures in pulmonary arterial hypertension
| Autor: | Rudolf K F, Oliveira, Rudolf K F, de Oliveira, Eloara V M, Ferreira, Roberta P, Ramos, Carolina M S, Messina, Carlos E B, Kapins, Célia M C, Silva, Jaquelina S, Ota-Arakaki |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine Cardiac Catheterization medicine.medical_specialty Hypertension Pulmonary Hemodynamics Context (language use) Sensitivity and Specificity Ventricular Function Left Internal medicine medicine Humans Pulmonary Wedge Pressure Pulmonary wedge pressure Aged Retrospective Studies Transplantation business.industry Reproducibility of Results Stroke Volume Middle Aged medicine.disease Pulmonary hypertension Preload Heart catheterization Ventricular pressure Cardiology Female Surgery Pulmonary venous hypertension Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Heart and Lung Transplantation. 33:157-162 |
| ISSN: | 1053-2498 |
| Popis: | Background Pulmonary arterial hypertension (PAH) is characterized by a pulmonary capillary wedge pressure (PCWP) of ≤15 mm Hg, given a normal left ventricular filling pressure (LVFP). However, recent studies have shown that, in PAH patients, diagnosis based on PCWP can erroneously classify a significant number of patients compared with diagnosis based on left ventricular end-diastolic pressure (LVEDP). Therefore, we sought to compare the diagnostic accuracy of end-expiratory PCWP and LVEDP measurements in patients suspected of having pulmonary hypertension (PH). Methods We reviewed the hemodynamic data from 122 patients suspected of having PH who underwent simultaneous right- and left-side heart catheterizations at a PH referral center from 2006 to 2011. Results PH was diagnosed in 105 patients, 79% of whom ( n = 83) showed a pre-capillary pattern according to the LVEDP measurement. Ninety percent of patients with PCWP ≤15 mm Hg were correctly classified as having pre-capillary PH. However, 39% of patients with a PCWP >15 mm Hg had LVEDP ≤15 mm Hg and would have been erroneously diagnosed with pulmonary venous hypertension based on their PCWP measurements alone. The sensitivity and specificity was 0.89 and 0.64, respectively. A Bland-Altman analysis of the PCWP and LVEDP measurements revealed a mean bias of 0.3 mm Hg with 95% limits of agreement of −7.2 to 7.8 mm Hg. Conclusions A PCWP ≤15 mm Hg was found to be a reliable indicator of normal LVFP in pre-capillary PH patients. When measured properly and analyzed in the clinical context, PCWP is a valuable tool for accurate diagnosis of PAH. |
| Databáze: | OpenAIRE |
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