Repeatability of Pulmonary Pressure Measurements in Patients with Pulmonary Hypertension

Reply: Will the Real Pulmonary Pressure Please Stand Up?

“… Sedation: as per our standard right heart catheterization (RHC) protocol, intravenous sedation or analgesia is hardly ever used for the procedure. All patients in our study received local anesthesia using 5 ml of 1% lidocaine ( 1 ), which is unlikely to have affected our hemodynamic measurements. Overdamping: all precautions were taken to avoid this phenomenon that particularly affects the systolic and diastolic pressures but less so the mean pulmonary pressure.…”

“…Sedation: as per our standard right heart catheterization (RHC) protocol, intravenous sedation or analgesia is hardly ever used for the procedure. All patients in our study received local anesthesia using 5 ml of 1% lidocaine ( 1 ), which is unlikely to have affected our hemodynamic measurements.…”

Will the Real Pulmonary Pressure Please Stand Up?

“…We read with interest the article by Melillo and colleagues ( 1 ) and appreciated their delineation of pitfalls in the hemodynamic evaluation of pulmonary hypertension (PH). They observed pressure variability despite meticulously performed right heart catheterizations (RHCs), which should mitigate measurement error.…”

“…It is possible that a smaller fluid volume may also lead to a meaningful increase in left-heart filling pressures, particularly in cases of high-normal PAWP. Documentation of the amount of fluid already administered by the time of the second measurement may be relevant, as most of the PAWP changes in the study by Melillo and colleagues ( 1 ) corresponded to an increase in PAWP values (76%; 22/29), and the median baseline PAWP was 15 mm Hg for those whose values changed upon recheck. PAC balloon inflation: The authors commented on using previously described criteria ( 3 ), but it is unclear if PAWP oximetry was routinely obtained for greater accuracy.…”

“…The findings of Melillo and colleagues ( 1 ) highlight the importance of establishing a pretest probability for precapillary or postcapillary PH before proceeding with RHC ( 4 ). High-normal PAWP values in patients with risk factors or with echocardiographic suggestion of left-heart disease would warrant provocative maneuvers ( 2 ).…”