Author + information
- S1936879815022086-8cefe0d5774f50532cdf1fc1d21172b3Zaher Fanari1,
- S1936879815022086-a3abbe1e3cae04cf69e83bca9551cb38Kasaiah Makam2,
- S1936879815022086-f7497ad5d2a54c31ead4e69ce563f4f7Mahmudul Haque3,
- S1936879815022086-4da21c14bede91df01a85d905361bc77Sumaya Hammami1 and
- S1936879815022086-6f3bdc6adf26038f1a66378946357a02Andrew Doorey3
Pulmonary arterial hypertension (PAH) is typically distinguished from pulmonary venous hypertension (PVH) by documenting a pulmonary capillary wedge pressure (PCWP) < 15 mm Hg. However, PCWP has uncertain utility in establishing PAH. Other suggests using left ventricular end-diastolic pressure (LVEDP) instead. We aim to compare both parameters to the “gold standard” measurement of direct “mean left atrial pressure (m LAP)” obtained through transeptal access.
We examined hemodynamic data from 25 patients with pulmonary hypertension undergoing simultaneous right-heart and left-heart catheterization with transeptal puncture to evaluate mean left atrial pressure.
Among 25 patients with severe pulmonary hypertension, acquiring a reliable conformed PCWP was not possible in 4 patients (16%). In the remaining cohort of 21 patients, when we used mLAP as the gold standard, the classification of PAH vs. PVH changed in 4/21 (19%) when PCWP was used and in 5/21 patients (24%) when LVEDP was used. PCWP had better correlation with mean mLAP when compared with LVEDP (R2= 0.76 and R2= 0.65 respectively).
A PCWP that can be used to discriminate PAH from PVH is either not easy to be obtained or is unreliable in roughly one-third of patients with severe pulmonary hypertension. LVEDP is even less reliable than PCWP in discriminating PAH and PVH. Reliance on PCWP or LVEDP may result in the dangerous or cost-ineffective use of pulmonary vasodilators for patients with left-heart disease. Direct assessment of mLAP may be beneficial in the classification of pulmonary hypertension and guiding therapeutic decisions.