Demographics and Outcomes of Patients Diagnosed With Pulmonary Hypertension With Pulmonary Capillary Wedge Pressures 16 to 18 mm Hg

Frost, Adaani E.; Farber, Harrison W.; Barst, Robyn J.; Miller, Dave P.; Elliott, C. Gregory; McGoon, Michael D.

doi:10.1378/chest.11-1387

Cited by 56 publications

(49 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In many patients with LHD, PAWP may be reduced to <15 mmHg with diuretics [72][73][74]. For this reason, the effect of an acute volume challenge on left heart filling pressures has been considered [75].…”

Section: 111mentioning

confidence: 99%

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

et al. 2015

View full text Add to dashboard Cite

Guidelines summarize and evaluate all available evidence on a particular issue at the time of the writing process, with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

show abstract

Section: 111mentioning

confidence: 99%

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

et al. 2015

View full text Add to dashboard Cite

show abstract

“…The LHF patient cohort in our study displays specific characteristics, with relatively elevated PVR and pulmonary artery pressures. From the REVEAL registry, a cohort with a clinical diagnosis of PAH was described with elevated wedge pressures between 16 and 18 mmHg who nonetheless, in many ways, behaved like pure group 1 patients [37]. The flip side is the recognition that some patients with heart failure with preserved ejection fraction, in particular those on diuretic medications, may have a wedge pressure of ⩽15 mmHg and an elevated PVR at the time of RHC.…”

Section: Figurementioning

confidence: 99%

Noninvasive identification of left-sided heart failure in a population suspected of pulmonary arterial hypertension

et al. 2015

View full text Add to dashboard Cite

Exclusion of pulmonary hypertension secondary to left-sided heart disease (left heart failure (LHF)) is pivotal in the diagnosis of pulmonary arterial hypertension (PAH). In case of doubt, invasive measurements are recommended. The aim of the present study was to investigate whether it is possible to diagnose LHF using noninvasive parameters in a population suspected of PAH. 300 PAH and 80 LHF patients attended our pulmonary hypertension clinic before August 2010, and were used to build the predictive model. 79 PAH and 55 LHF patients attended our clinic from August 2010, and were used for prospective validation.A medical history of left heart disease, S deflection in V1 plus R deflection in V6 in millimetres on ECG, and left atrial dilation or left valvular heart disease that is worse than mild on echocardiography were independent predictors of LHF. The derived risk score system showed good predictive characteristics: R 2 =0.66 and area under the curve 0.93. In patients with a risk score ⩾72, there is 100% certainty that the cause of pulmonary hypertension is LHF. Using this risk score system, the number of right heart catheterisations in LHF may be reduced by 20%.In a population referred under suspicion of PAH, a predictive model incorporating medical history, ECG and echocardiography data can diagnose LHF noninvasively in a substantial percentage of cases. @ERSpublications A risk score system can identify left-heart failure as alternative PH cause in patients suspected of PAH clinically http://ow.ly/JAIkR

show abstract

“…In this clinical scenario, a potential solution is fluid challenge during RHC, which can reduce the likelihood of misdiagnosis in patients with left ventricular dysfunction [3]. Fluid challenge during RHC has been explored to differentiate occult pulmonary venous hypertension from PAH [40,41], defined as an increase in PAWP to >15 mmHg [39]. In a retrospective review of 207 patients meeting baseline haemodynamic criteria for PAH, an increase in PAWP to >15 mmHg following fluid challenge with an intravenous fluid bolus of 0.5 L of normal saline over 5-10 min suggested diastolic left ventricular dysfunction in 22.2% of patients [39].…”

Section: Technical Errors and Complicationsmentioning

confidence: 99%

Right heart catheterisation: best practice and pitfalls in pulmonary hypertension

Rosenkranz¹,

2015

View full text Add to dashboard Cite

Right heart catheterisation (RHC) plays a central role in identifying pulmonary hypertension (PH) disorders, and is required to definitively diagnose pulmonary arterial hypertension (PAH). Despite widespread acceptance, there is a lack of guidance regarding the best practice for performing RHC in clinical practice. In order to ensure the correct evaluation of haemodynamic parameters directly measured or calculated from RHC, attention should be drawn to standardising procedures such as the position of the pressure transducer and catheter balloon inflation volume. Measurement of pulmonary arterial wedge pressure, in particular, is vulnerable to over-or under-wedging, which can give rise to false readings. In turn, errors in RHC measurement and data interpretation can complicate the differentiation of PAH from other PH disorders and lead to misdiagnosis. In addition to diagnosis, the role of RHC in conjunction with noninvasive tests is widening rapidly to encompass monitoring of treatment response and establishing prognosis of patients diagnosed with PAH. However, further standardisation of RHC is warranted to ensure optimal use in routine clinical practice. @ERSpublications Right heart catheterisation is required to diagnose pulmonary arterial hypertension, but standardisation is needed http://ow.ly/TI6Gr

show abstract

Demographics and Outcomes of Patients Diagnosed With Pulmonary Hypertension With Pulmonary Capillary Wedge Pressures 16 to 18 mm Hg

Cited by 56 publications

References 21 publications

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Noninvasive identification of left-sided heart failure in a population suspected of pulmonary arterial hypertension

Right heart catheterisation: best practice and pitfalls in pulmonary hypertension

Contact Info

Product

Resources

About