Right heart catheterisation: best practice and pitfalls in pulmonary hypertension

Rosenkranz, Stephan; Preston, Ioana R.

doi:10.1183/16000617.0062-2015

Cited by 167 publications

(142 citation statements)

References 51 publications

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“…Although averaging intravascular pulmonary pressures over the respiratory cycle may be better estimates of transmural pressures, particularly, during exercise in COPD patients [35], we employed end-expiratory measurements based on the recommendations for resting measurements [17]. We cannot discard an expiratory increase of RAP and PAWP that may explain the significantly higher values of the COPD patients [41]. Concomitantly, the pulse PAP and mPAP may decrease during spontaneous expiration in COPD patients at rest [42].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary arterial wall disease in COPD and interstitial lung diseases candidates for lung transplantation

et al. 2017

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BackgroundPulmonary hypertension (PH) associated with lung disease has the worst prognosis of all types of PH. Pulmonary arterial vasculopathy is an early event in the natural history of chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). The present study characterized the alterations in the structure and function of the pulmonary arterial (PA) wall of COPD and ILD candidates for lung transplantation (LTx).MethodsA cohort of 73 patients, 63 pre-LTx (30 COPD, 33 ILD), and ten controls underwent simultaneous right heart catheterisation and intravascular ultrasound (IVUS). Total pulmonary resistance (TPR), capacitance (Cp), and the TPR-Cp relationship were assessed. PA stiffness and the relative area of wall thickness were estimated as pulse PA pressure/IVUS pulsatility and as [(external sectional area-intimal area)/external sectional area] × 100, respectively.ResultsTwenty-seven percent of patients had pulmonary arterial wedge pressure > 15 mmHg and were not analyzed. PA stiffness and the area of wall thickness were increased in comparison with controls, even in patients without PH (p < 0.05). ILD patients showed a significant higher PA stiffness, and lower Cp beyond mean PA pressure (mPAP) and lower area of wall thickness than COPD patients (p < 0.05). TPR-Cp relationship was shifted downward left for ILD patients.ConclusionsSignificant increase of PA stiffness and area of wall thickness were present even in patients without PH and can make the diagnosis of pulmonary vasculopathy at a preclinical stage in PH-lung disease candidates for LTx. ILD patients showed the worst PA stiffness and Cp with respect to COPD.

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Section: Discussionmentioning

confidence: 99%

Pulmonary arterial wall disease in COPD and interstitial lung diseases candidates for lung transplantation

et al. 2017

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“…All patients underwent RHC in a resting state, according to standard protocol (11). The cardiac output (CO) of patients with idiopathic PAH (IPAH) was measured by thermodilution, and the CO of patients with congenital heart disease (CHD)/PAH was measured using the Fick method (11).…”

Section: Methodsmentioning

confidence: 99%

Evaluation of two-dimensional strain echocardiography for quantifying right ventricular function in patients with pulmonary arterial hypertension

Liu

Wang

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The aim of the current study was to evaluate the use of two-dimensional strain echocardiography (2DS) in quantifying right ventricular (RV) function in patients with pulmonary arterial hypertension (PAH). A total of 41 patients with PAH and 40 healthy control patients were recruited to the study. 2DS was used to determine the strain (ε) and strain rate (SR) of basal, middle and apical segments of the RV free wall. The aforementioned indicators were compared with measurements of RV function taken by conventional ultrasound and right heart catheterization. The ε and SR of all segments of the right ventricular free wall were significantly lower in the PAH group, as compared with the control group (P<0.05). In the PAH group, the ε and SR of the middle and apical segments were significantly lower compared with basal segments (P<0.01). The SR of the apical segments were positively correlated with the area and diameter of the right ventricular. The ε of the apical segments were positively correlated with RV area, diameter and systolic function. The ε and SR of apical segments were positively correlated with pulmonary artery pressure and pulmonary vascular resistance measured by right heart catheterization. These findings indicated that 2DS can accurately evaluate RV longitudinal systolic function.

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“…Cardiac catheterisation can be used to distinguish pre-and post-capillary PH [23,33,34]. As well as assessing pulmonary haemodynamics, catheterisation can be used to identify coronary artery disease and valvular disease and to measure left-sided filling pressure, if necessary by direct measurement of left ventricular pressure [4,6].…”

Section: Diagnostic Methodsmentioning

confidence: 99%

Under pressure: pulmonary hypertension associated with left heart disease

Farber

Gibbs

2015

Eur Respir Rev

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Pulmonary hypertension (PH) associated with left heart disease (PH-LHD) is the most common type of PH, but its natural history is not well understood. PH-LHD is diagnosed by right heart catheterisation with a mean pulmonary arterial pressure ⩾25 mmHg and a pulmonary capillary wedge pressure >15 mmHg. The primary causes of PH-LHD are left ventricular dysfunction of systolic and diastolic origin, and valvular disease. Prognosis is poor and survival rates are low. Limited progress has been made towards specific therapies for PH-LHD, and management focuses on addressing the underlying cause of the disease with supportive therapies, surgery and pharmacological treatments. Clinical trials of therapies for pulmonary arterial hypertension in patients with PH-LHD have thus far been limited and have provided disappointing or conflicting results. Robust, long-term clinical studies in appropriate target populations have the potential to improve the outlook for patients with PH-LHD. Herein, we discuss the knowledge gaps in our understanding of PH-LHD, and describe the current unmet needs and challenges that are faced by clinicians when identifying and managing patients with this disease. @ERSpublications Pulmonary hypertension due to left heart disease is associated with multiple unmet medical needs http://ow.ly/TFET8Case study part 1: initial assessment A 63-year-old male with hypertension, diabetes mellitus, dyslipidaemia, coronary artery disease and obstructive sleep apnoea presented to the clinic with worsening dyspnoea upon exertion (World Health Organization (WHO) functional class IIIb). Echocardiography revealed a normal-sized left ventricle, left ventricular ejection fraction (LVEF) of 35-40%, delayed left ventricular diastolic relaxation, normal left atrium, right ventricular dilation with moderately depressed systolic function, mild right atrial enlargement, flattened interventricular septum, dilated inferior vena cava, and a pulmonary artery systolic pressure of 85 mmHg. Computed tomography pulmonary angiography revealed no pulmonary embolus or parenchymal lung disease. The patient failed to reach the target heart rate in a treadmill exercise test, but there was no evidence of myocardial ischaemia. Pulmonary function testing and right heart catheterisation (RHC) were performed (table 1).Question 1: Based on these data, what would be your initial assessment of this patient? This real-life patient case study highlights some of the many factors that can make diagnosing pulmonary hypertension associated with left heart disease (PH-LHD) challenging. Based on the information presented, would you diagnose this patient with PH-LHD?

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Right heart catheterisation: best practice and pitfalls in pulmonary hypertension

Cited by 167 publications

References 51 publications

Pulmonary arterial wall disease in COPD and interstitial lung diseases candidates for lung transplantation

Pulmonary arterial wall disease in COPD and interstitial lung diseases candidates for lung transplantation

Evaluation of two-dimensional strain echocardiography for quantifying right ventricular function in patients with pulmonary arterial hypertension

Under pressure: pulmonary hypertension associated with left heart disease

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