Role of Pulmonary Artery Wedge Pressure Saturation During Right Heart Catheterization

Viray, Michael C.; Bonno, Eric L.; Gabrielle, Nicholas D.; Maron, Bradley A.; Atkins, Jessica; Amoroso, Nicholas; Fernandes, Valerian; Maran, Anbukarasi; Nielsen, Christopher D.; Powers, Eric R.; Steinberg, Daniel; Todoran, Thomas M.; Salvo, Thomas G. Di; Jackson, Gregory R.; Houston, Brian A.; Tedford, Ryan J.

doi:10.1161/circheartfailure.120.007981

Cited by 30 publications

(15 citation statements)

References 5 publications

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“…If no reliable PAWP curve can be obtained, or if the PAWP values are implausible, additional measurement of LV end-diastolic pressure should be considered to avoid misclassification. Saturations taken with the catheter in the wedged position can confirm an accurate PAWP [128].…”

Section: Cardiopulmonary Exercise Testingmentioning

confidence: 98%

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Humbert

Kovàcs²,

Hoeper³

et al. 2022

Eur Respir J

1,030

1,631

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Section: Cardiopulmonary Exercise Testingmentioning

confidence: 98%

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Humbert

Kovàcs²,

Hoeper³

et al. 2022

Eur Respir J

1,030

1,631

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“…17,18 PAWP measurement was determined by fluoroscopic confirmation and by characteristic waveform appearance. In addition, PAWP is confirmed to be occlusive either by three attempts of PAWP saturation to achieve occlusion peripheral oxygen saturation (i.e., >90% or within 5% of peripheral arterial saturation) 19 or by demonstration of stasis of contrast on fluoroscopy. Cardiac output (CO) was determined using the thermodilution method.…”

Section: Right Heart Hemodynamic Assessmentmentioning

confidence: 99%

Noninvasive determinants of pulmonary hypertension in interstitial lung disease

et al. 2023

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Pulmonary hypertension (PH) in interstitial lung disease (ILD) is associated with increased mortality and impaired exertional capacity. Right heart catheterization is the diagnostic standard for PH but is invasive and not readily available. Noninvasive physiologic evaluation may predict PH in ILD. Forty‐four patients with PH and ILD (PH‐ILD) were compared with 22 with ILD alone (non‐PH ILD). Six‐min walk distance (6MWD, 223 ± 131 vs. 331 ± 125 m, p = 0.02) and diffusing capacity for carbon monoxide (DLCO, 33 ± 14% vs. 55 ± 21%, p < 0.001) were lower in patients with PH‐ILD. PH‐ILD patients exhibited a lower gas‐exchange derived pulmonary vascular capacitance (GX CAP , 251 ± 132 vs. 465 ± 282 mL × mmHg, p < 0.0001) and extrapolated maximum oxygen uptake (VO 2max ) (56 ± 32% vs. 84 ± 37%, p = 0.003). Multivariate analysis was performed to determine predictors of VO 2 max . GX CAP was the only variable that predicted extrapolated VO 2 max among PH‐ILD and non‐PH ILD patients. Receiver operating characteristic curve analysis assessed the ability of individual noninvasive variables to distinguish between PH‐ILD and non‐PH ILD patients. GX CAP (area under the curve [AUC] 0.85 ± 0.04, p < 0.0001) and delta ETCO 2 (AUC 0.84 ± 0.04, p < 0.0001) were the strongest predictors of PH‐ILD. A CART analysis selected GX CAP , estimated right ventricular systolic pressure (eRVSP) by echocardiogram, and FVC/DLCO ratio as predictive variables for PH‐ILD. With this analysis, the AUC improved to 0.94 (sensitivity of 0.86 and sensitivity of 0.93). Patients with a GX CAP ≤ 416 mL × mmHg had an 82% probability of PH‐ILD. Patients with GX CAP ≤ 416 mL × mmHg and high FVC/DLCO ratio >1.7 had an 80% probability of PH‐ILD. Patients with GX CAP ≤ 416 mL × mmHg and an elevated eRVSP by echocardiogram >43 mmHg had 100% probability of PH‐ILD. The incorporation of GX CAP with either eRVSP or FVC/DLCO ratio distinguishes between PH‐ILD and non‐PH‐ILD with high probability and may therefore assist in determining the need to proceed with a diagnostic right heart catheterization and potential initiation of pulmonary arterial hypertension‐directed therapy in PH‐ILD patients.

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“…We acknowledge that this lack of confirmation can also be a source of error. 30 However, definition of wedge position by fluoroscopy and waveform analysis alone is current practice in many laboratories. Fourth, the setting of our study was selected because all patients underwent AVR early after cardiac catheterization, which affects hemodynamics owing to afterload reduction and thereby may have an impact on prognosis.…”

Section: Discussionmentioning

confidence: 99%

Wedge Pressure vs Left Ventricular End-Diastolic Pressure for Pulmonary Hypertension Classification and Prognostication in Severe Aortic Stenosis

et al. 2021

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Role of Pulmonary Artery Wedge Pressure Saturation During Right Heart Catheterization

Cited by 30 publications

References 5 publications

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Noninvasive determinants of pulmonary hypertension in interstitial lung disease

Wedge Pressure vs Left Ventricular End-Diastolic Pressure for Pulmonary Hypertension Classification and Prognostication in Severe Aortic Stenosis

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