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. 2023 Jun 20;13(2):104-110.
doi: 10.1055/s-0043-1769932. eCollection 2023 Apr.

Importance of the Mean Rate of Pressure Change of the Pulmonary Artery (dP/dt mean PA) in Patients with Pulmonary Arterial Hypertension

Theodoros Sinanis  1 , Alexander Schmeißer  2
Affiliations

Importance of the Mean Rate of Pressure Change of the Pulmonary Artery (dP/dt mean PA) in Patients with Pulmonary Arterial Hypertension

Theodoros Sinanis et al. Avicenna J Med. .

Abstract

Background Pulmonary arterial hypertension (PAH) is a rare disease of cardiopulmonary circulation characterized by elevated pressure in the pulmonary artery. The right-heart catheter is the gold standard for diagnosis, but there is interest in identifying additional prognostic indicators. The aim of this study was to examine the importance of the rate of pressure change of the pulmonary artery (dP/dt mean PA) in patients with PAH. Methods We retrospectively analyzed data from 142 patients with PAH (exclusively clinical group 1) and examined the statistical correlation of dP/dt mean PA with vascular, right ventricular, and clinical parameters. Data was collected mostly from the right heart catheterization and the transthoracal echocardiography at presentation. Results dP/dt mean PA showed a significant correlation with systolic pressure of the pulmonary artery ( n = 142, R 2 = 56%, p < 0.001), pulmonary vascular resistance ( n = 142, R 2 = 51%, p < 0.001), the rate of pressure change in the right ventricle ( n = 142, R 2 = 53%, p < 0.001), and the right ventricular fractional area change ( n = 110, R 2 = 51%, p < 0.001). Receiver operating characteristic curve analysis showed that dP/dt mean PA had the highest prognostic value in predicting increase in the 6-minute walk test and decrease in the N-terminal-probrain natriuretic peptide after the initiation of PAH therapy, with an area under the curve of 0.73. Conclusion Our findings suggest that dP/dt mean PA may be a useful prognostic indicator in the treatment of patients with PAH, and further research is warranted to validate this parameter.

Keywords: 6-minute walk test; pulmonary artery; pulmonary hypertension.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Graphical representation of a calculation of the dP/dt mean pulmonary artery (PA) from a right heart catheterization pressure curve.
Fig. 2
Fig. 2
Graphical representation of the correlation of the dP/dt mean PA (X Axis in mm Hg) and the ( A ) CPA (Y Axis in mL/mm Hg), ( B ) the PVR (Y axis in Wood Units) and the ( C ) PAs (Y axis in mm Hg). N = 142 patients in all regressions. D is graphical representation of the relationship of PVR (Wood Units) and CPA (Y axis in mL/mm Hg). p -Values in all cases < 0.001, R 2 >0.5. CPA, pulmonary artery compliance; PA, pulmonary artery; PVR, pulmonary vascular resistance.
Fig. 3
Fig. 3
Graphical representation of the correlation of dP/dt mean PA (X Axis in mm Hg) and ( A ) of the dP/dt mean RV (Y Axis in mm Hg/s) and ( B ) RV-FAC (Y Axis in %). p -Values in all cases < 0.001, R 2 >0.5. PA, pulmonary artery; RV-FAC, right ventricular fractional area change.
Fig. 4
Fig. 4
Results of the ROC analysis in respect of the combination endpoint (simultaneous improvement of the 6MWT and reduction of the NT-proBNP). ( A ) dP/dt mean PA, ( B ) dP/dt mean RV. AUC in ( A ) 0.73 in ( B ) 0.72. 6MWT, 6-minute walk test; AUC, area under the curve; PA, pulmonary artery; NT-proBNP, N-terminal-probrain natriuretic peptide; ROC, receiver operating characteristic.
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