Hemodynamic Responses to Rapid Saline Loading

Fujimoto, Naoki; Borlaug, Barry A.; Lewis, Gregory D.; Hastings, Jeffrey L.; Shafer, Keri M.; Bhella, Paul S.; Carrick–Ranson, Graeme; Levine, Benjamin D.

doi:10.1161/circulationaha.112.111302

Cited by 182 publications

(81 citation statements)

References 39 publications

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“…20 Fluid challenge during RHC to elicit latent pulmonary venous hypertension (PVH), discussed in a recent summary statement on group 2 PH, 21 is routinely performed in a minority of centers. However, there is increasing evidence that this simple test may be useful in identifying latent PVH, 22,23 with over 20% of patients exhibiting an increase in PWP >15 mmHg after rapid infusion of 500 mL normal saline. 22,24 Given that exercise testing and fluid challenge are not commonly performed at most PH centers, additional study of these maneuvers in patients with PAH and group 2 PH to define sensitivity and specificity is needed before firm consensus recommendations and widespread adoption of this practice should occur.…”

Section: Discussionmentioning

confidence: 99%

Variability in Hemodynamic Evaluation of Pulmonary Hypertension at Large Referral Centers

et al. 2014

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Despite consensus guidelines for right heart catheterization (RHC) in the diagnosis of pulmonary arterial hypertension (PAH), considerable differences exist in the performance of RHC, interpretation of hemodynamic data, and frequency of RHC performance in patients with established disease. These differences may lead to variability in diagnosis or treatment of PAH. We sought to gather information on the standard practice of RHC for the diagnosis and management of PAH from experienced pulmonary vascular disease specialists. We developed a semiquantitative online survey of diagnosis and treatment patterns of pulmonary hypertension and distributed it to physicians at pulmonary hypertension centers in the United States. Thirty of 50 physicians completed the survey: 20 pulmonologists and 10 cardiologists, all of whom reported treating >100 patients with PAH in the past year. All respondents perform RHC in ≥90% of patients with suspected PAH. All physicians determine the pulmonary wedge pressure at end expiration; however, only half of respondents personally review tracings. Physicians differed in frequency of vasodilator testing (8 of 24 performed testing in >90% of patients with PAH), fluid challenge and exercise (19 of 30 performed testing in <25% of patients with PAH for both). Most physicians (70%) report repeating RHC between 6 months and 1 year after PAH treatment initiation. Variability exists in the interpretation of hemodynamic tracings and performance of vasodilator, fluid, and exercise challenges in the management of PAH by experienced physicians in the United States. Additional consensus guidelines delineating appropriate adjunctive testing to standardize the diagnosis of PAH are needed.

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Section: Discussionmentioning

confidence: 99%

Variability in Hemodynamic Evaluation of Pulmonary Hypertension at Large Referral Centers

et al. 2014

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“…Normal left ventricular diastolic function keeps both pressures low (<12 mm Hg), although some increase may be observed during stress conditions, such as volume overload 1 and exercise. 2 When these changes occur within a range of transient periods and in a normal heart, they are well tolerated because of the pulmonary vasculature ability to recruit and distend the capillary network.…”

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confidence: 99%

Pulmonary Hypertension in Heart Failure Preserved Ejection Fraction

Guazzi

2014

Circ: Heart Failure

102

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“…However, larger volumes may cause a rise in PAWP, even in healthy individuals. 83 Thus, rapid infusion of intravenous fluid while monitoring for a rise in the PAWP may help to uncover pulmonary venous hypertension, but the results must be interpreted cautiously.…”

Section: Fluid Challengementioning

confidence: 99%

Pulmonary Hypertension in Patients with Heart Failure and Preserved Ejection Fraction: Differential Diagnosis and Management

et al. 2016

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Abstract:The most common cause of pulmonary hypertension (PH) due to left heart disease (LHD) was previously rheumatic mitral valve disease. However, with the disappearance of rheumatic fever and an aging population, nonvalvular LHD is now the most common cause of group 2 PH in the developed world. In this review, we examine the challenge of investigating patients who have PH and heart failure with preserved ejection fraction (HF-pEF), where differentiating between pulmonary arterial hypertension (PAH) and PH-LHD can be difficult, and also discuss the entity of combined precapillary and postcapillary PH. Given the proven efficacy of targeted therapy for the treatment of PAH, there is increasing interest in whether these treatments may benefit selected patients with PH associated with HF-pEF, and we review current trial data.Keywords: pulmonary arterial hypertension, combined pre-and postcapillary pulmonary hypertension, heart failure with preserved ejection fraction, diastolic dysfunction. (Table 1) by a mean pulmonary arterial pressure (PAP) of ≥25 mmHg at right heart catheterization (RHC), with the most recent classification identifying 5 groups (Fig. 1): 2 group 1, pulmonary arterial hypertension (PAH), which can be idiopathic (IPAH) or associated with other conditions (most frequently systemic sclerosis and congenital heart disease); group 2, PH owing to left heart disease (PH-LHD); group 3, PH owing to lung disease (PH-Lung); group 4, chronic thromboembolic PH (CTEPH); and group 5, PH owing to unclear or multifactorial mechanisms. Accurate classification of disease is important in identifying the most appropriate form of therapy 3 and defining prognosis. 4 This requires a systematic approach to the evaluation of the breathless patient and an awareness of conditions associated with particular forms of PH. Pulmonary hypertension (PH) is definedThe most commonly encountered form of PH is related to left heart disease (LHD). 5,6 PH may be seen in heart failure with preserved ejection fraction (HF-pEF) and heart failure with reduced ejection fraction (HF-rEF), and its presence in HF-rEF is known to convey a poor prognosis. 7 HF-pEF accounts for approximately half of all new heart failure (HF) diagnoses. 8,9 While HF-pEF was initially believed to confer a better outcome than HF-rEF, the two conditions have equivalent morbidity and mortality. [10][11][12] The prevalence of PH-HF-pEF is unclear and varies with diagnostic criteria. Studies quote rates of between 53% and 83% (based on an echocardiographic systolic PAP [sPAP] > 35 mmHg or mean PAP > 25 mmHg at RHC). 13-15 A recent study 16 found that only 7% of heart failure (HF) patients had PH (but used an sPAP cutoff of ≥45 mmHg at echocardiography). PATHOPHYSIOLOGY OF PH-LHDPAH, PH-Lung, and CTEPH are precapillary in nature, caused by obstruction or destruction of the pulmonary arterial bed, whereas PH-LHD is thought to be primarily due to postcapillary abnormalities. 5 In patients with LHD, an increase in left ventricular (LV) and left atrial (LA) filling pressu...

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Hemodynamic Responses to Rapid Saline Loading

Cited by 182 publications

References 39 publications

Variability in Hemodynamic Evaluation of Pulmonary Hypertension at Large Referral Centers

Variability in Hemodynamic Evaluation of Pulmonary Hypertension at Large Referral Centers

Pulmonary Hypertension in Heart Failure Preserved Ejection Fraction

Pulmonary Hypertension in Patients with Heart Failure and Preserved Ejection Fraction: Differential Diagnosis and Management

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