Derivation of Mean Pulmonary Artery Pressure from Noninvasive Parameters

Steckelberg, Rachel C.; Tseng, Andrew; Nishimura, Rick A.; Ommen, Steve R.; Sorajja, Paul

doi:10.1016/j.echo.2013.01.006

Cited by 45 publications

(33 citation statements)

References 15 publications

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“…Our empirical equation has been further confirmed in a total of 166 individuals studied with micromanometer-tipped catheter, of whom 57% had pulmonary hypertension (PH) caused by many different conditions (3). A recent fluid-filled catheter pressure study performed in 307 patients, mainly with left heart diseases, has documented an empirical equation strictly identical to ours, namely mPAP ϭ 0.61 sPAP ϩ 1.95 mmHg (8). Very recently, a retrospective fluid-filled catheter pressure study of 463 congestive heart failure patients with reduced ejection fraction and no PH, venous PH, or mixed venous and superimposed arterial PH has also reported an empirical equation remarkably similar to ours, namely mPAP ϭ 0.615 sPAP ϩ 3 mmHg (7).…”

supporting

confidence: 60%

Letter to the editor: “Pulsatile pulmonary artery pressure: are fluid-filled catheters accurate in pulmonary hypertension?”

Chemla

Castelain

Hervé

2013

American Journal of Physiology-Heart and Circulatory Physiology

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supporting

confidence: 60%

Letter to the editor: “Pulsatile pulmonary artery pressure: are fluid-filled catheters accurate in pulmonary hypertension?”

Chemla

Castelain

Hervé

2013

American Journal of Physiology-Heart and Circulatory Physiology

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“…In particular, the beneficial effect of PDE5i in HFpEF reported by Guazzi M et al may be attributable to the more advanced PH at baseline [12]. In the RELAX trial, however, the pulmonary pressure was not specified as an entry criterion, and participants had a mean of PASP 41 mmHg and calculated mPAP of 27 mmHg [13, 40]. Therefore, the lack of a beneficial effect of PDE5i in the RELAX trial may be associated with the relatively low pulmonary pressures and the small proportion of participants with Cpc-PH.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary hemodynamics and effects of phosphodiesterase type 5 inhibition in heart failure: a meta-analysis of randomized trials

Hwang

Park

Yoon

et al. 2017

BMC Cardiovasc Disord

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BackgroundPrevious studies suggested that phosphodiesterase 5 inhibitors (PDE5i) have a beneficial effect in patients with heart failure (HF), although the results were inconsistent. We performed a meta-analysis to evaluate the effect of PDE5i in HF patients, and investigated the relationship between PDE5i effects and pulmonary hemodynamics.MethodWe searched PubMed, EMBASE and the Cochrane Library for randomized controlled trials (RCTs) that compared PDE5i with placebo in HF with reduced ejection fraction (HFrEF) or HF with preserved EF (HFpEF). PDE5i effects were interpolated according to baseline pulmonary arterial pressure (PAP) or according to changes in PAP after PDE5i treatment.ResultsThirteen RCTs enrolling 898 HF patients, and two sub-analysis studies with different study outcomes, were included in the meta-analysis. Among patients with HFrEF, PDE5i improved peak VO2 (mean difference [MD], 3.76 mL/min/kg; 95% confidence interval [CI], 3.27 to 4.25; P < 0.00001), VE/VCO2 slope (MD, −6.04; 95% CI, −7.45 to −4.64; P < 0.00001), LVEF (MD, 4.30%; 95% CI, 2.18 to 6.42; P < 0.0001), and pulmonary vascular resistance (MD, −80.74 dyn·sec/cm5; 95% CI, −110.69 to −50.79; P < 0.00001). The effects of PDE5i in patients with HFpEF were heterogeneous. Meta-regression analyses indicated that the beneficial effect of PDE5i was related to the baseline PAP as well as the extent of PDE5i-mediated PAP decrease.ConclusionPDE5i improved pulmonary hemodynamics and exercise capacity in patients with HFrEF, but not in HFpEF. The relationship between the benefits by PDE5i with the baseline PAP and the changes in PAP indicates the therapeutic potential of PDE5i in HF according to pulmonary hemodynamics.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0576-4) contains supplementary material, which is available to authorized users.

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“…6, 7 Steckelberg et al also reported that a similar formula, MPAP=0.61×SPAPTR+1.95 mmHg, was useful over a wide range of pressures for different etiologies of PH. 8 Conversely, Aduen et al reported that MPAP calculated from adding the mean systolic RV-right atrial (RA) gradient derived by tracing the TR velocity flow to the RA pressure (MPAPTR) had an accuracy and precision similar to that of MPAP as estimated by the Chemla method (MPAPChemla). 2,9 However, the number of patients with CTEPH included in those previous reports was insufficient.…”

mentioning

confidence: 99%

Mean Pulmonary Artery Pressure Using Echocardiography in Chronic Thromboembolic Pulmonary Hypertension

Kasai

Matsumura

Sugiura

et al. 2016

Circ J

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Background: Mean pulmonary arterial pressure (MPAP) is an important pulmonary hemodynamic parameter used in the management of patients with chronic thromboembolic pulmonary hypertension (CTEPH). We compared echocardiography-derived estimates of MPAP with right heart catheterization (RHC) to identify reliable noninvasive methods of estimating MPAP-derived RHC (MPAPRHC) in these patients. Methods and Results:Echocardiography and RHC were performed in 56 patients with CTEPH (60.5±12.0 years; 44 females). We measured the tricuspid regurgitation (TR) pressure gradient (TRPG) using echocardiography. The mean systolic right ventricular (RV)-right atrial (RA) gradient was calculated by tracing the TR time velocity flow. Systolic and mean pulmonary artery pressures (SPAPTR and MPAPTR) estimated from TRPG and mean systolic RV-RA gradient were calculated by adding RA pressure based on the inferior vena cava. MPAPChemla was calculated using Chemla's formula: 0.61×SPAPTR+2 mmHg. MPAPRHC and pulmonary vascular resistance were 35.9±11.3 mmHg and 6.6±3.6 Wood units, respectively. The mean difference from MPAPRHC and limits of agreement were −1.5 mmHg and −19.6 to 16.5 mmHg for MPAPTR, and −4.6 mmHg and −24.5 to 15.2 mmHg for MPAPChemla. Accuracy within 10 mmHg and 5 mmHg of MPAPRHC was 80.4% and 46.4% for MPAPTR, and 71.4% and 48.2% for MPAPChemla, respectively.Conclusions: MPAPTR and MPAPChemla are reliable estimates for MPAPRHC in patients with CTEPH. (Circ J 2016; 80: 1259 -1264

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Derivation of Mean Pulmonary Artery Pressure from Noninvasive Parameters

Cited by 45 publications

References 15 publications

Letter to the editor: “Pulsatile pulmonary artery pressure: are fluid-filled catheters accurate in pulmonary hypertension?”

Letter to the editor: “Pulsatile pulmonary artery pressure: are fluid-filled catheters accurate in pulmonary hypertension?”

Pulmonary hemodynamics and effects of phosphodiesterase type 5 inhibition in heart failure: a meta-analysis of randomized trials

Mean Pulmonary Artery Pressure Using Echocardiography in Chronic Thromboembolic Pulmonary Hypertension

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