Title: The Relationship between Pulmonary Artery Pulse Pressure and Pulmonary Artery Wedge Pressure during Exercise in Health and in Patients with Suspected Pulmonary Hypertension
Abstract: <h3>Purpose</h3> Exercise during right heart catheterization (RHC) can demonstrate cardiopulmonary hemodynamic abnormalities not evident at rest. The relationships of pulmonary artery pressure (PAP) or pulmonary artery wedge pressure (PAWP) to cardiac output (CO) do not fully consider that PAP and PAWP should also be closely related. Therefore, we sought to expand our understanding of cardiopulmonary hemodynamic abnormalities by calculating the ratio of PA pulse pressure to PAWP during exercise in health and in patients with dyspnea and uncertain mechanisms of pulmonary hypertension (PH). <h3>Methods</h3> Data from 36 healthy individuals (median, Q1-Q3; 55, 50-60 yr, 50% male) and 85 consecutive patients (60, 49-71 yr, 48% male) referred for RHC and exercise (semi-upright submaximal cycling) were analysed. <h3>Results</h3> In our healthy control population, the upper 95% confidence intervals were determined for the change from rest to exercise in mean PAP over CO (ΔmPAP/ΔCO; 3.2 WU), PAWP over CO (ΔPAWP/ΔCO; 2 mmHg/L/min), and exercise PA pulse pressure over PAWP (PP/PAWP; 2.5). In the dyspneic population, ΔmPAP/ΔCO < or >3.2 WU identified patients on the vertical and horizontal limbs of the pulmonary resistance-pulmonary compliance relationship respectively. While patients with a ΔmPAP/ΔCO <3.2 WU largely had a ΔPAWP/ΔCO below 2 mmHg/L/min, patients with a ΔmPAP/ΔCO >3.2 WU exhibited a broad ΔPAWP/ΔCO both below and above 2 mmHg/L/min. Exercise PP/PAWP >2.5 revealed subpopulations within each ΔmPAP/ΔCO group with inappropriate PP/PAWP responses (Figure 1). <h3>Conclusion</h3> Among dyspneic patients, we identified abnormal exercise phenotypes based upon ΔmPAP/ΔCO, ΔPAWP/ΔCO, and PP/PAWP responses. Our study refines quantitative classification of abnormal exercise hemodynamic phenotypes based on an improved understanding of the interrelationship between left heart filling pressure and pulmonary vascular behaviour.
Publication Year: 2020
Publication Date: 2020-03-30
Language: en
Type: article
Indexed In: ['crossref']
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Cited By Count: 1
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