Hemodynamic assessment of pulmonary hypertension

Abstract

There has been significant progress in our understanding of the pathobiology, epidemiology and prognosis of pulmonary vascular disease and, over the past few years, there has been an explosion of clinical therapeutic trials for pulmonary arterial hypertension (PAH). The increasing number of different conditions now associated with PAH and the appearance of new diagnostic techniques have led to a need for a systematic diagnostic approaches and a new disease classification, which has resulted in notable improvements in the quality and efficacy of clinical care. We appreciate traditional resting right heart catheterization techniques (which still remain the gold standard for diagnosing PAH and managing patients on therapy) and look forward to novel invasive techniques (e.g. intravascular ultrasound) that add greatly to our understanding of right ventricle and pulmonary circulation, and for the interpretation of data from clinical trials as well.

Keywords: Intravascular ultrasound; Pulmonary artery stiffness; Pulmonary hypertension; Right heart catheterization.

Figure 1

Occluded pulmonary artery pressure vs pulmonary capillary wedge pressure. Modified from Lupi Herrera et al. Arch Cardiol Mex 2008; 78: 95-113.

Figure 2

Timing of the pulmonary artery occlusion pressure waves. PACEP program, http://www.pacep.org.

Figure 3

Biexponential curve fitting for estimation of pulmonary capillary pressure (Pcap) by intersection of the fast and the slow components of the pressure decay curve, or by the extrapolation of the exponential fitting of the slow component of the pressure decay curve to the moment of occlusion. Modified from Souza et al. Critical Care 2005, 9: R132-R138.

Figure 4

Typical pulmonary artery pressure tracing showing the PA waveform analysis.

Figure 5

Example of the pulmonary artery decay curve showing the calculus of Zup.