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Normal and Abnormal Relationships of Pulmonary Artery to Wedge Pressure During Exercise.


ABSTRACT: Background Resting right heart catheterization can assess both left heart filling and pulmonary artery (PA) pressures to identify and classify pulmonary hypertension. Although exercise may further elucidate hemodynamic abnormalities, current pulmonary hypertension classifications do not consider the expected interrelationship between PA and left heart filling pressures. This study explored the utility of this relationship to enhance the classification of exercise hemodynamic phenotypes in pulmonary hypertension. Methods and Results Data from 36 healthy individuals (55, 50-60 years, 50% male) and 85 consecutive patients (60, 49-71 years, 48% male) with dyspnea and/or suspected pulmonary hypertension of uncertain etiology were analyzed. Right heart catheterization was performed at rest and during semiupright submaximal cycling. To classify exercise phenotypes in patients, upper 95% CIs were identified from the healthy individuals for the change from rest to exercise in mean PA pressure over cardiac output (?mPAP/?CO ?3.2 Wood units [WU]), pulmonary artery wedge pressure over CO (?PAWP/?CO ?2 mm Hg/L per minute), and exercise PA pulse pressure over PAWP (PP/PAWP ?2.5). Among patients with a ?mPAP/?CO ?3.2 WU, the majority (84%) demonstrated a ?PAWP/?CO ?2 mm Hg/L per minute, yet 23% demonstrated an exercise PP/PAWP >2.5. Among patients with a ?mPAP/?CO >3.2 WU, 37% had an exercise PP/PAWP >2.5 split between ?PAWP/?CO groups. Patients with normal hemodynamic classification declined from 52% at rest to 36% with exercise. Conclusions The addition of PP/PAWP to classify exercise hemodynamics uncovers previously unrecognized abnormal phenotypes within each ?mPAP/?CO group. Our study refines abnormal exercise hemodynamic phenotypes based on an understanding of the interrelationship between PA and left heart filling pressures.

SUBMITTER: Bentley RF 

PROVIDER: S-EPMC7763717 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Normal and Abnormal Relationships of Pulmonary Artery to Wedge Pressure During Exercise.

Bentley Robert F RF   Barker Madeleine M   Esfandiari Sam S   Wright Stephen P SP   Valle Felipe H FH   Granton John T JT   Mak Susanna S  

Journal of the American Heart Association 20201106 22


Background Resting right heart catheterization can assess both left heart filling and pulmonary artery (PA) pressures to identify and classify pulmonary hypertension. Although exercise may further elucidate hemodynamic abnormalities, current pulmonary hypertension classifications do not consider the expected interrelationship between PA and left heart filling pressures. This study explored the utility of this relationship to enhance the classification of exercise hemodynamic phenotypes in pulmon  ...[more]

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