Hemodynamic assessment of pulmonary hypertension

Abstract

There has been significant progress in our understanding of the pathobiology, epidemiology and prognosis of pulmonary vascular disease and, over the past few years, there has been an explosion of clinical therapeutic trials for pulmonary arterial hypertension (PAH). The increasing number of different conditions now associated with PAH and the appearance of new diagnostic techniques have led to a need for a systematic diagnostic approaches and a new disease classification, which has resulted in notable improvements in the quality and efficacy of clinical care. We appreciate traditional resting right heart catheterization techniques (which still remain the gold standard for diagnosing PAH and managing patients on therapy) and look forward to novel invasive techniques (e.g. intravascular ultrasound) that add greatly to our understanding of right ventricle and pulmonary circulation, and for the interpretation of data from clinical trials as well.

Estimating Right Ventricular Stroke Work and the Pulsatile Work Fraction in Pulmonary Hypertension

“…[8][9][10][11][12][13]33 Implications A proper estimation of the various aspects of RV function is of paramount importance in patients with PH. [1][2][3][4][5][6][7][8][9] As pulmonary circulation is highly pulsatile, it is logical to take into account both the steady and pulsatile components in the calculation of RVSW [2][3][4]15 and our improved formula may thus be useful. Furthermore, increased mPAP may tend to preserve low pulsatile RVSW fraction in patients with PH and nonfailing RV.…”

“…This may be especially questionable at the right-sided heart level, as pulmonary circulation is much more pulsatile than at the left systemic counterpart. [2][3][4][5][6][7]19 A high value of the pulsatile RVSW fraction could be potentially detrimental for the failing RV as an increased fraction of energy is then wasted without usefully contributing to forward stroke volume.…”

Pulmonary Artery/Central Venous Pressure Monitoring in Adults

“…Scope and Impact of the Problem Pulmonary artery pressure (PAP), pulmonary artery occlusion pressure (PAOP), and central venous pressure (CVP) may aid in the differential diagnosis in pulmonary hypertension [1][2][3][4] and may be beneficial in complex shock states. 5 Less invasive hemodynamic methods, in conjunction with the patient's medical history, may also be useful in the differential diagnosis of cardiogenic shock.…”

Pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension: How can patients be better selected?

“…sPAP and dPAP mainly depend on total PVR and pulmonary artery stiffness and wave reflection. Increasing total PVR results in both sPAP and dPAP increase while increasing pulmonary artery stiffness and wave reflection generate a wider pPAP without significant mPAP change [14,18,19] . A more proximal occlusive site by the fibrotic organized thromboembolic material incorporated into the native vascular intima causes a higher pulmonary artery stiffness.…”