Continuous ambulatory pulmonary artery pressure monitoring. A new method using a transducer tipped catheter and a simple recording system.

Lévy, Richard; Cunningham, David A.; Shapiro, Leonard M.; Wright, Christine; Mockus, L; Fox, KM

doi:10.1136/hrt.55.4.336

Cited by 18 publications

(3 citation statements)

References 12 publications

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“…Previous studies have been limited to patients confined to bed in the coronary care unit and have used fluid filled catheter systems.2 35 10 The transducer tipped catheter technique used in this study is both accurate and allows for full ambulation. 8 We have shown that changes in pulmonary artery diastolic pressure do not precede ST segment elevation in spontaneous variant angina and this confirms the results of previous studies.2 1112 Symptomatic and asymptomatic ST segment changes have been recorded by ambulatory monitoring'3 and in the coronary care unit.2 In our study episodes of symptomatic ST segment elevation were not always associated with a rise in pulmonary artery diastolic pressure. The presence or absence of a rise in pulmonary artery diastolic pressure was related to the duration of ST segment elevation in some patients.…”

Section: Discussionsupporting

confidence: 89%

The haemodynamic response to myocardial ischaemia in ambulant patients with variant angina.

Lévy¹,

Shapiro²,

Wright³

et al. 1986

Heart

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The haemodynamic response to myocardial ischaemia in patients with variant angina during ambulatory activity is unknown. Ambulatory pulmonary artery pressure monitoring with a transducer tipped catheter and simultaneous frequency modulated electrocardiograms was used to assess changes in left ventricular function in five male patients (mean age 51.8 years) during variant angina; four patients had coronary artery stenosis and one had normal coronary arteries. Two hundred and seventy hours of ambulatory recordings were analysed. Twenty episodes (12 painful, 8 silent) of ST segment change greater than 1 mm occurred. Episodes tended to occur more frequently in the early morning hours. Six episodes of painful ST elevation were associated with a rise in pulmonary artery diastolic pressure. In the remaining episodes ST segment elevation was of shorter duration and there was no rise in pulmonary artery diastolic pressure. Pain was usually a late feature. Silent ST segment elevation occurred at rest and pulmonary artery diastolic pressure increased in all but one episode. Silent exertional ST segment depression was associated with a greater increase in pulmonary artery diastolic pressure than that seen during ST segment elevation. ST segment depression preceded or followed ST segment elevation in two episodes. The onset of ST segment elevation nearly always preceded the onset of a rise in pulmonary artery diastolic pressure. Ergometrine maleate provocation produced a rise in pulmonary artery diastolic pressure in three patients. In one there was no response to 1000 micrograms but spontaneous episodes of ST segment elevation were recorded during ambulatory monitoring. Treadmill exercise resulted in both ST segment elevation and depression with a similar haemodynamic response during both types of electrocardiographic change. When there is important coronary artery disease in two or more vessels ST segment changes may occur in different territories during treadmill exercise and during spontaneous episodes. Ambulatory pulmonary artery diastolic pressure monitoring is a useful technique for the investigation of variant angina.

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Section: Discussionsupporting

confidence: 89%

The haemodynamic response to myocardial ischaemia in ambulant patients with variant angina.

Lévy¹,

Shapiro²,

Wright³

et al. 1986

Heart

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“…13 22 23 In this study we have been able to measure the left ventricular filling pressure indirectly by measuring pulmonary artery diastolic pressure in ambulant subjects. Patients with coronary artery disease had a higher 24 hour median pulmonary artery diastolic pressure than the control group and patients with syndrome X.…”

Section: Discussionmentioning

confidence: 99%

Diurnal variation in left ventricular function: a study of patients with myocardial ischaemia, syndrome X, and of normal controls.

Lévy¹,

Cunningham²,

Shapiro³

et al. 1987

Heart

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SUMMARY Angina can occur in the early morning. The mechanism of this is unclear and both haemodynamic changes and coronary artery spasm may be important. The purpose of this study was to investigate the diurnal variation in pulmonary artery diastolic pressure (an indirect measure of left ventricular filling pressure) in six normal subjects, 18 patients with coronary artery disease, five with variant angina, and six with syndrome X. A transducer tipped catheter and a simple recording system were used to record ambulatory pulmonary artery diastolic pressure for 24 hours. Variation in pulmonary artery diastolic pressure was related to the timing of episodes of ST segment depression and elevation by simultaneously recording a frequency modulated electrocardiogram. Episodes of ST segment change occurred predominantly in the early morning (midnight to 6 am) in variant angina (eight out of 14 episodes) whereas in syndrome X all episodes were recorded during the day. In coronary artery disease both painful and painless episodes were distributed throughout the day, with 10 out of 67 episodes occurring between midnight and 6 am. A similar diurnal variation in pulmonary artery diastolic pressure was seen in the groups-that is, values were low during the day and higher at night, with the maximum values between midnight and 6 am. The 24 hour median pulmonary artery diastolic pressure was higher in patients with coronary artery disease than in the control group and those with syndrome X.The finding that pulmonary artery diastolic pressure, and therefore left ventricular end diastolic pressure, is greatest in the early morning may represent the background haemodynamic state in which other factors lead to myocardial ischaemia during these hours.There is a well described diurnal variation in several physiological variables such as blood pressure, heart rate, cortisol, and catecholamines.'-4 This may have adverse consequences; for example myocardial infarction and cerebral infarction both show diumal variation.56 Angina may occur not only when the patient is active through the day but also in the early hours of the morning.79 Various pathophysiological mechanisms have been proposed, including an increase in myocardial oxygen consumption in patients with severe coronary artery Requests for reprints to Dr Richard D Levy,

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“…Monitoring systems of this type are particularly suitable for pressure measurement in ambulant or exercising patients because of the micromanometer tip. Such systems are not new [11] and have been used previously in patients with pulmonary hypertension secondary to heart disease [12]. The catheter provides high fidelity signals of PAP but not cardiac output.…”

Section: The Cathetermentioning

confidence: 99%

Pulmonary artery pressure measurement during exercise testing in patients with suspected pulmonary hypertension

Raeside¹,

Smith²,

Brown³

et al. 2000

Eur Respir J

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It is recognized that exercise produces abnormally large increases in pulmonary artery pressure in patients with pulmonary vascular disease as a consequence of a variety of disorders, but the relationship between pressure and cardiopulmonary exercise performance is poorly understood. This lack of understanding is due (in part) to difficulty making measurements of pulmonary haemodynamics using conventional fluid filled catheters. This article seeks to improve understanding by comparing variables measured during formal exercise testing with simultaneous measurements of pulmonary artery pressure using a micro-manometer tipped catheter.Ten patients with suspected pulmonary hypertension were studied using a micromanometer tipped pulmonary artery catheter, during cardiopulmonary exercise testing.Ventilatory equivalents for oxygen and carbon dioxide correlated with the pulmonary artery pressure measured on exercise, but oxygen pulse and oxygen uptake did not. Ventilatory equivalents, noninvasively measured during exercise, may merit further study as potential surrogates of pulmonary artery pressure and hence be useful in identifying individuals at risk of developing pulmonary hypertension. Eur Respir J 2000; 16: 282±287.

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Continuous ambulatory pulmonary artery pressure monitoring. A new method using a transducer tipped catheter and a simple recording system.

Cited by 18 publications

References 12 publications

The haemodynamic response to myocardial ischaemia in ambulant patients with variant angina.

The haemodynamic response to myocardial ischaemia in ambulant patients with variant angina.

Diurnal variation in left ventricular function: a study of patients with myocardial ischaemia, syndrome X, and of normal controls.

Pulmonary artery pressure measurement during exercise testing in patients with suspected pulmonary hypertension

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