Performance of Pulmonary Capillary Wedge Pressure (Pcwp) vs. Left Ventricular End Diastolic Pressure (Lvedp) in the Diagnosis/Classification of Patients With Suspect Pulmonary Arterial Hypertension (Pah)

Soto, Francisco J.; Siegel, Ronald; Marks, David; Kleczka, James; Woods, Timothy; Maloney, James P.; Syed, Aslam; Syed, Amjad; Gupta, Sonika; Presberg, Kenneth W.

doi:10.1378/chest.128.4_meetingabstracts.137s-a

Cited by 9 publications

(5 citation statements)

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“…Amongst those patients with PAH according to the PAWP, 53.5% were found to have elevated LVEDP. SOTO et al [25] reported in abstract form 131 right and left cardiac catheterisations performed in their centre and demonstrated that 37% of patients with PAH according to PAWP had OPVH according to resting LVEDP. Our estimate of 38% overdiagnosis of PAH is consistent with these previous estimates.…”

Section: Discussionmentioning

confidence: 99%

High prevalence of occult left heart disease in scleroderma-pulmonary hypertension

et al. 2012

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Our study aimed to determine the prevalence of occult left-heart disease in patients with scleroderma and pulmonary hypertension. In patients with pulmonary hypertension (mean pulmonary artery pressure (mean PAP) o25 mmHg), differentiation between pre-and post-capillary pulmonary hypertension has been made according to pulmonary artery wedge pressure (PAWP) less than or more than 15 mmHg, respectively.We performed a retrospective chart review of 107 scleroderma patients. All patients with suspected pulmonary hypertension had routine right or left heart catheterisation with left ventricular end-diastolic pressure (LVEDP) measurement pre-/post-fluid challenge. We extracted demographic, haemodynamic and echocardiographic data. Patients were classified into one of four groups: haemodynamically normal (mean PAP,25 mmHg); pulmonary venous hypertension (PVH) (mean PAPo25 mmHg, PAWP.15 mmHg); occult PVH (mean PAPo25 mmHg, PAWPf15 mmHg, LVEDP.15 mmHg before or after fluid challenge); and pulmonary arterial hypertension (PAH) (mean PAPo25 mmHg, PAWPf15 mmHg and LVEDPf15 mmHg before or after fluid challenge).53 out of 107 patients had pulmonary hypertension. Based on the PAWP-based definition, 29 out of 53 had PAH and 24 out of 53 had PVH. After considering the resting and post-fluid-challenge LVEDP, 11 PAH patients were reclassified as occult PVH. The occult PVH group was haemodynamically, echocardiographically and demographically closer to the PVH group than the PAH group.PVH had high prevalence in our scleroderma-pulmonary hypertension population. Distinguishing PAH from PVH with only PAWP may result in some PVH patients being misclassified as having PAH. @ERSpublications Left heart catheterisation with saline infusion helps in the diagnosis of suspected PH in scleroderma

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Section: Discussionmentioning

confidence: 99%

High prevalence of occult left heart disease in scleroderma-pulmonary hypertension

et al. 2012

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“…For example, a potential for significant discrepancy between left-heart filling pressure numbers determined by left ventricular (LV) end-diastolic pressure versus pulmonary capillary wedge pressure has been found. 7 In this study, approximately 40% of patients with PH whose pulmonary capillary wedge pressure was no more than15 mmHg were found to have LV end-diastolic pressure greater than 15 mmHg, therefore affecting their classification status. Likewise, the methodology for the measurement of right heart pressures can vary between practitioners.…”

Section: Characteristics Of Hemodynamic Measurements and Specific Casmentioning

confidence: 71%

Cardiopulmonary Hemodynamics in Pulmonary Hypertension: Pressure Tracings, Waveforms, and More

Soto

Kleczka

2008

Advances in Pulmonary Hypertension

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“…Unfortunately, until new specific hemodynamic parameters that can accurately discriminate between PAH vs PVH are proposed and validated, many of these patients will be inappropriately misclassified and will endure unnecessary stress and treatment, and potentially detrimental effects. 12,13,19,20 Thus, the ability to establish a very clear pretest probability for PVH at the beginning of the workup might be one of the best tools available to face such challenging cases.…”

Section: Resultsmentioning

confidence: 99%

“…This is very important since recent data point to the risk of solely relying on the use of PCWP to determine LV filling pressures. 19,20 Based on those studies, a large number of PVH cases could be misclassified as PAH because of PCWP measurement limitations.…”

Section: Cmementioning

confidence: 99%

Pulmonary Venous Hypertension: A Pulmonologist's Perspective

Soto

2011

Advances in Pulmonary Hypertension

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Increased pulmonary hypertension (PH) awareness in the general public and among health providers has led to an increase in referral of patients who are found to have elevated estimates of pulmonary artery systolic pressure (PASP) on a transthoracic echocardiogram (TTE), without other strong features suggestive of precapillary PH (pulmonary arterial hypertension; PAH). Some of these patients undergo TTE as part of their workup for unexplained dyspnea that appears out of proportion to their other comorbidities. Many of these patients are older individuals with underlying conditions such as systemic hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD), and obstructive sleep apnea (OSA). While some of them may have PAH, accumulated experience in the PH community suggests that many of these patients will be ultimately found to have elevated left ventricular (LV) filling pressures and impaired LV relaxation as the cause of their dyspnea and elevation of pulmonary pressures on TTE.12 These findings are consistent with a form of Group 2 PH termed LV diastolic dysfunction, more recently termed heart failure with preserved left ventricular systolic function (HFpEF) (Table 1).2 Other forms of Group 2 PH, defined as “pulmonary hypertension owing to left-sided heart disease,” include LV systolic dysfunction or left-sided valvular disease.2 For the purpose of this article, the term pulmonary venous hypertension (PVH) will be used to refer to Group 2 PH, HFpEF. Being able to accurately discriminate PAH (precapillary; Group 1 PH) from PVH (postcapillary; Group 2 PH) is critical to determine and apply the appropriate treatment course. This is a difficult, yet frequently encountered clinical dilemma, which can fall into a “gray zone” with respect to clinical classification. We will provide important clinical features that should heighten the clinician's awareness and suspicion of this rapidly growing phenomenon. These features are critical when trying to differentiate PAH (Group 1 PH) from PVH (Group 2 PH).

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Performance of Pulmonary Capillary Wedge Pressure (Pcwp) vs. Left Ventricular End Diastolic Pressure (Lvedp) in the Diagnosis/Classification of Patients With Suspect Pulmonary Arterial Hypertension (Pah)

Cited by 9 publications

References 0 publications

High prevalence of occult left heart disease in scleroderma-pulmonary hypertension

High prevalence of occult left heart disease in scleroderma-pulmonary hypertension

Cardiopulmonary Hemodynamics in Pulmonary Hypertension: Pressure Tracings, Waveforms, and More

Pulmonary Venous Hypertension: A Pulmonologist's Perspective

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