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1 Dept of Cardiac and Respiratory Physiology, Bicêtre Hospital, Faculty of Medicine, University of Paris XI, Le Kremlin-Bicêtre, 2 Dept of Thoracic and Vascular Surgery, Marie Lannelongue Hospital, le Plessis-Robinson, France, 3 Intensive care unit, Erasme Hospital, Brussels, Belgium
CORRESPONDENCE: D. Chemla, Service EFCR, Broca 7, Hôpital de Bicêtre, 78 rue du Général Leclerc, 94 275, Le Kremlin Bicêtre, Paris, France. Fax: 33 145213778. E-mail: denis.chemla@bct.ap-hop-paris.fr
Keywords: cor pulmonale, pulmonary hypertension, pulmonary vasodilatory reserve, right atrial pressure, right ventricle, walk test
Received: July 29, 2002
Accepted August 5, 2002
Abstract
Pulmonary hypertension is characterised by the chronic elevation of pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) leading to right ventricular enlargement and hypertrophy. Pulmonary hypertension may result from respiratory and cardiac diseases, the most severe forms occurring in thromboembolic and primary pulmonary hypertension.
Pulmonary hypertension is most often defined as a mean PAP >25 mmHg at rest or >30 mmHg during exercise, the pressure being measured invasively with a pulmonary artery catheter. Doppler echocardiography allows serial, noninvasive follow-up of PAPs and right heart function. When the adaptive mechanisms of right ventricular dilatation and hypertrophy cannot compensate for the haemodynamic burden, right heart failure occurs and is associated with poor prognosis.
The haemodynamic profile is the major determinant of prognosis. In both primary and secondary pulmonary hypertension, special attention must be paid to the assessment of pulmonary vascular resistance index (PVRI), right heart function and pulmonary vasodilatory reserve.
Recent studies have stressed the prognostic values of exercise capacity (6-min walk test), right atrial pressure, stroke index and vasodilator challenge responses, as well as an interest in new imaging techniques and natriuretic peptide determinations. Overall, careful haemodynamic evaluation may optimise new diagnostic and therapeutic strategies in pulmonary hypertension.
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