RT Journal Article
SR Electronic
T1 Reliance on end-expiratory wedge pressure leads to misclassification of pulmonary hypertension
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 425
OP 434
DO 10.1183/09031936.00209313
VO 44
IS 2
A1 Barbara L. LeVarge
A1 Eugene Pomerantsev
A1 Richard N. Channick
YR 2014
UL http://erj.ersjournals.com/content/44/2/425.abstract
AB Current guidelines recommend measurement of pulmonary artery wedge pressure (PAWP) at end-expiration. However, this recommendation is not universally followed and may not be physiologically appropriate. We investigated the performance of end-expiratory PAWP in the evaluation of precapillary pulmonary hypertension patients. 329 spontaneously breathing patients undergoing right heart catheterisation were retrospectively classified as having a precapillary, post-capillary or mixed phenotype based on standardised clinical criteria. Tracings were reviewed to compare end-expiratory PAWP with PAWP averaged throughout the respiratory cycle; these values were correlated with the clinical classifications. Predictors of large respirophasic variation in PAWP were determined. Elevated end-expiratory PAWP (>15 mmHg) occurred in 29% of subjects with precapillary phenotype. There were no differences in demographics or clinical history between those with elevated and normal end-expiratory PAWP. Those with elevated end-expiratory PAWP had greater right atrial pressure and respirophasic PAWP variation. Among all subjects, the magnitude of respirophasic variation in PAWP was positively correlated with body mass index and respirophasic variation in left ventricular end-diastolic pressure. A significant proportion of precapillary pulmonary hypertension patients have end-expiratory PAWP >15 mmHg. Spontaneous positive end-expiratory intrathoracic pressure may contribute; in those cases, PAWP averaged throughout respiration may be a more accurate measurement. Strict use of end-expiratory pulmonary artery wedge pressure leads to over diagnosis of pulmonary venous hypertension http://ow.ly/vNHMj