High prevalence of occult pulmonary venous hypertension revealed by fluid challenge in pulmonary hypertension.
نویسندگان
چکیده
BACKGROUND Determining the cause for pulmonary hypertension is difficult in many patients. Pulmonary arterial hypertension (PAH) is differentiated from pulmonary venous hypertension (PVH) by a wedge pressure (PWP)>15 mm Hg in PVH. Patients undergoing right heart catheterization for evaluation of pulmonary hypertension may be dehydrated and have reduced intravascular volume, potentially leading to a falsely low measurement of PWP and an erroneous diagnosis of PAH. We hypothesized that a fluid challenge during right heart catheterization would identify occult pulmonary venous hypertension (OPVH). METHODS AND RESULTS We reviewed the results of patients undergoing fluid challenge in our pulmonary hypertension database from 2004 to 2011. Baseline hemodynamics were obtained and repeated after infusion of 0.5 L of normal saline for 5 to 10 minutes. Patients were categorized as OPVH if PWP increased to >15 mm Hg after fluid challenge. Baseline hemodynamics in 207 patients met criteria for PAH. After fluid challenge, 46 patients (22.2%) developed a PWP>15 mm Hg and were reclassified as OPVH. Patients with OPVH had a greater increase in PWP compared with patients with PAH, P<0.001, and their demographics and comorbid illnesses were similar to patients with PVH. There were no adverse events related to fluid challenge. CONCLUSIONS Fluid challenge at the time of right heart catheterization is easily performed, safe, and identifies a large group of patients diagnosed initially with PAH, but for whom OPVH contributes to pulmonary hypertension. These results have implications for therapeutic trials in PAH and support the routine use of fluid challenge during right heart catheterization in patients with risk factors for PVH.
منابع مشابه
High Prevalence of Occult Pulmonary Venous Hypertension Revealed by Fluid Challenge in Pulmonary Hypertension Robbins et al: Fluid Challenge in Pulmonary Hypertension
متن کامل
HIGH PREVALENCE OF OCCULT LEFT HEART DISEASE IN SCLERODERMA- PULMONARY HYPERTENSION Running Head: Occult pulmonary venous hypertension in scleroderma
Question: What is the prevalence of occult left-heart disease in patients with scleroderma (SCL) and pulmonary hypertension (PH)? In patients with PH (mean pulmonary artery pressure mPAP≥25mmHg), differentiation between pre/post capillary PH has been made according to pulmonary artery wedge pressure (PAWP) less/more than15mmHg, respectively. Patients and Methods: Retrospective chart review of 1...
متن کاملHigh prevalence of occult left heart disease in scleroderma-pulmonary hypertension.
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)≥25 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, respe...
متن کاملشیوع هیپرتانسیون پولمونر و عوامل مرتبط با آن در بیماران همودیالیزی
Background and purpose: Pulmonary hypertension (PH) has been reported in hemodialysis patients, but there are scant studies about its prevalence and mechanisms. The aim of this study was to determine the prevalence of pulmonary hypertension in hemodialysis patients and to study some of its possible etiologic factors. Materials and methods: Ïn this cross-sectional study, the prevalence of p...
متن کاملEvaluation of Pulmonary Hypertension In First Degree Relatives Of Patients With Primary Pulmonary Hypertension
Background: Pulmonary hypertension (PH) was defined for the first time in 1951 as primary pulmonary hypertension (PPH). Some studies emphasized on the role of genetics in the development of pulmonary hypertension in family members of affected patients. So, in this study we evaluated the prevalence of pulmonary hypertension in first degree family of patients with documented PPH. Methods: In thi...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Circulation. Heart failure
دوره 7 1 شماره
صفحات -
تاریخ انتشار 2014