TY - JOUR
T1 - Relationship between right and left-sided filling pressures in 1000 patients with advanced heart failure
AU - Drazner, Mark H.
AU - Hamilton, Michele A.
AU - Fonarow, Gregg
AU - Creaser, Julie
AU - Flavell, Carol
AU - Warner Stevenson, Lynne
N1 - Funding Information:
Work supported in part by Fannie E. Rippel Foundation, Basking Ridge, New Jersey.
Copyright:
Copyright 2007 Elsevier B.V., All rights reserved.
PY - 1999/11
Y1 - 1999/11
N2 - Background: Elevated left ventricular filling pressures present a major target of therapy for symptomatic heart failure but are difficult to assess directly. Because the relationship of left- and right-sided pressures remains ill defined in chronic heart failure, this study compared 3 right-sided measurements (right atrial [RA] pressure, pulmonary artery systolic [PAS] pressure, and severity of tricuspid regurgitation [TR]) to the pulmonary capillary wedge (PCW) pressure. Methods: Hemodynamic measurements and echocardiography were available from 1000 patients undergoing transplant evaluation. Right atrial and PAS pressure, and TR severity were compared to PCW pressure. For 754 patients undergoing repeat measurements, changes in RA and PAS pressures were compared to PCW changes.Results: Right atrial pressure correlated with PCW pressure (r = 0.64), regardless of etiology or TR severity. Right atrial pressure changes correlated with PCW changes (r = 0.62). Discordance was defined as either RA ≥ 10 mm Hg despite PCW < 22 mm Hg (6%) or RA < 10 mm Hg despite PCW ≥ 22 mm Hg (15%). For detection of PCW ≥ 22 mm Hg, positive predictive values were 88% for RA ≥ 10 mm Hg, 95% for PAS ≥ 60 mm Hg, and 79% for ≥ moderate TR. Pulmonary artery systolic pressure correlated very closely with PCW (r = 0.79), and could be estimated as 2 x PCW. Reduction in PAS pressure during therapy was strongly determined by PCW pressure reduction (r = 0.67). Conclusions: Accurate estimation of RA pressure can potentially guide therapy of left ventricular filling pressures in approximately 80% of chronic heart failure patients without obvious non-cardiac disease. In this population, elevated PAS pressures are largely determined by elevated left-sided filling pressures. Copyright (C) 1999 International Society for Heart and Lung Transplantation.
AB - Background: Elevated left ventricular filling pressures present a major target of therapy for symptomatic heart failure but are difficult to assess directly. Because the relationship of left- and right-sided pressures remains ill defined in chronic heart failure, this study compared 3 right-sided measurements (right atrial [RA] pressure, pulmonary artery systolic [PAS] pressure, and severity of tricuspid regurgitation [TR]) to the pulmonary capillary wedge (PCW) pressure. Methods: Hemodynamic measurements and echocardiography were available from 1000 patients undergoing transplant evaluation. Right atrial and PAS pressure, and TR severity were compared to PCW pressure. For 754 patients undergoing repeat measurements, changes in RA and PAS pressures were compared to PCW changes.Results: Right atrial pressure correlated with PCW pressure (r = 0.64), regardless of etiology or TR severity. Right atrial pressure changes correlated with PCW changes (r = 0.62). Discordance was defined as either RA ≥ 10 mm Hg despite PCW < 22 mm Hg (6%) or RA < 10 mm Hg despite PCW ≥ 22 mm Hg (15%). For detection of PCW ≥ 22 mm Hg, positive predictive values were 88% for RA ≥ 10 mm Hg, 95% for PAS ≥ 60 mm Hg, and 79% for ≥ moderate TR. Pulmonary artery systolic pressure correlated very closely with PCW (r = 0.79), and could be estimated as 2 x PCW. Reduction in PAS pressure during therapy was strongly determined by PCW pressure reduction (r = 0.67). Conclusions: Accurate estimation of RA pressure can potentially guide therapy of left ventricular filling pressures in approximately 80% of chronic heart failure patients without obvious non-cardiac disease. In this population, elevated PAS pressures are largely determined by elevated left-sided filling pressures. Copyright (C) 1999 International Society for Heart and Lung Transplantation.
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U2 - 10.1016/S1053-2498(99)00070-4
DO - 10.1016/S1053-2498(99)00070-4
M3 - Article
C2 - 10598737
AN - SCOPUS:0032730153
SN - 1053-2498
VL - 18
SP - 1126
EP - 1132
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 11
ER -