Summary of recommendations for the haemodynamic and angiographic assessment of the pulmonary circulation. Joint statement of the Polish Cardiac Society’s Working Group on Pulmonary Circulation and Association of Cardiovascular Interventions

Abstract

Right heart catheterisation (RHC) is the 'gold standard' for haemodynamic assessment of the pulmonary circulation. For the diagnosis of pulmonary hypertension (PH), the guidelines of the European Society of Cardiology require a mean pulmonary arterial pressure ≥ 25 mm Hg to be confirmed by direct haemodynamic measurement. Additionally, RHC provides a lot of valuable information about the differential diagnosis and severity of PH, and also helps determine the patient's prognosis. Acute vasoreactivity testing performed in patients with pulmonary arterial hypertension is intended to identify the group of patients who should be treated with calcium channel blockers. Patients referred for heart transplantation require advanced pulmonary vascular disease to be ruled out either on resting examination or during vasoreactivity testing. RHC is a component of such interventional procedures as balloon atrial septostomy, closure of intracardiac shunts in congenital heart and great vessel defects, valvuloplasty for pulmonary valve stenosis, and pulmonary angioplasty. Pulmonary angiography is an examination recommended when selecting patients for pulmonary endarterectomy or balloon pulmonary angioplasty in thromboembolic PH. Due to the dynamic growth in the number of patients diagnosed with and treated for PH in Poland, the Boards of the Polish Cardiac Society's Working Group on Pulmonary Circulation and Association of Cardiovascular Interventions have undertaken a joint project to develop recommendations to standardise guidelines for RHC procedure, acute vasoreactivity testing and pulmonary angiography at cardiac wards and haemodynamic laboratories in Poland. This document has been prepared by experts delegated by the Working Group on Pulmonary Circulation and the Association of Cardiovascular Interventions, and subsequently approved by the Boards of both organs of the Polish Cardiac Society.

Characterization of Patients with Pulmonary Arterial Hypertension: Data from the Polish Registry of Pulmonary Hypertension (BNP-PL)

“…For the purpose of the present study, we analyzed the data of newly and previously diagnosed PAH adult (≥18 years old) patients who were under the care of the participating centers between 1 March 2018 and 30 September 2018. The diagnostic algorithm was based on current recommendations [11,[13][14][15][16][17][18][19]. Newly diagnosed patients were those whose diagnosis was established since 1 March 2018 (termed 'incident cases').…”

Changing the strategy of balloon pulmonary angioplasty resulted in a reduced complication rate in patients with chronic thromboembolic pulmonary hypertension. A single-centre European experience

“…Cardiac output (CO) was measured using a thermodilution technique. The pulmonary vascular resistance (PVR) and cardiac index (CI) were calculated according to the accepted standards [19]. Functional class was assessed using the Word Heath Organisation (WHO) classification.…”

Expert opinion on the creating and operating of the regional Pulmonary Embolism Response Teams (PERT). Polish PERT Initiative

“…At the beginning of transcatheter therapy for a patient with PE, a pulmonary artery angiography from the femoral or internal jugular vein should be performed initially using 5-7 F diameter pigtail catheters [21]. Pulmonary angiography enables visualization of thrombi not only in the main pulmonary, lobar or segmental arteries but even in smaller (subsegmental) vessels.…”