Sandeep Sahay, James Lane, Megan G Sharpe, David Toth, Deborah Paul, Matthew T Siuba, Adriano R Tonelli
{"title":"肺动脉楔压和心输出量测量方法对肺动脉高压血流动力学分类的影响。","authors":"Sandeep Sahay, James Lane, Megan G Sharpe, David Toth, Deborah Paul, Matthew T Siuba, Adriano R Tonelli","doi":"10.1513/AnnalsATS.202303-216OC","DOIUrl":null,"url":null,"abstract":"<p><p><b>Rationale:</b> Guidelines recommend using end-expiration pulmonary pressure measurements to determine the hemodynamic subgroups in pulmonary hypertension. Pulmonary artery wedge pressure (PAWP) determinations averaged across the respiratory cycle (PAWPav) instead of PAWP at end-expiration (PAWPee) and cardiac output (CO) measured by Fick (CO<sub>Fick</sub>) instead of thermodilution (CO<sub>TD</sub>) may affect the hemodynamic classification of pulmonary hypertension. <b>Objectives:</b> To assess the impact on the pulmonary hypertension hemodynamic classification of the use of PAWPee versus PAWPav as well as CO<sub>Fick</sub> versus CO<sub>TD</sub>. <b>Methods:</b> This was a single-center retrospective study of consecutive patients (<i>n</i> = 151) who underwent right heart catheterization with CO<sub>TD</sub>, CO<sub>Fick</sub>, PAWPee, and PAWPav. A secondary cohort consisted of consecutive patients (<i>n</i> = 71) who had mean pulmonary artery pressure at end-expiration (mPAPee) and mPAP averaged across the respiratory cycle (mPAPav) measured, as well as PAWPee and PAWPav. <b>Results:</b> The PAWPee and PAWPav were 16.8 ± 6.4 and 15.1 ± 6.8 mm Hg, respectively, with a mean difference of 1.7 ± 2.1 mm Hg. The CO<sub>TD</sub> and CO<sub>Fick</sub> determinations were 5.0 ± 2.4 and 5.3 ± 2.5 L/min, respectively, with a mean difference of -0.4 ± 1.3 L/min. The hemodynamic group distribution was significantly different when using PAWPee versus PAWPav, when using either CO<sub>TD</sub> or CO<sub>Fick</sub> (<i>P</i> < 0.001 for both comparisons), and these results were consistent in our secondary cohort. The pulmonary hypertension hemodynamic group distribution was not significantly different between CO<sub>TD</sub> and CO<sub>Fick</sub> when using either PAWPee or PAWPav. <b>Conclusions:</b> The methodology used to measure PAWP, either at end-expiration or averaged across the respiratory cycle, significantly impacts the hemodynamic classification of pulmonary hypertension.</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1752-1759"},"PeriodicalIF":6.8000,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact on Pulmonary Hypertension Hemodynamic Classification Based on the Methodology Used to Measure Pulmonary Artery Wedge Pressure and Cardiac Output.\",\"authors\":\"Sandeep Sahay, James Lane, Megan G Sharpe, David Toth, Deborah Paul, Matthew T Siuba, Adriano R Tonelli\",\"doi\":\"10.1513/AnnalsATS.202303-216OC\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Rationale:</b> Guidelines recommend using end-expiration pulmonary pressure measurements to determine the hemodynamic subgroups in pulmonary hypertension. Pulmonary artery wedge pressure (PAWP) determinations averaged across the respiratory cycle (PAWPav) instead of PAWP at end-expiration (PAWPee) and cardiac output (CO) measured by Fick (CO<sub>Fick</sub>) instead of thermodilution (CO<sub>TD</sub>) may affect the hemodynamic classification of pulmonary hypertension. <b>Objectives:</b> To assess the impact on the pulmonary hypertension hemodynamic classification of the use of PAWPee versus PAWPav as well as CO<sub>Fick</sub> versus CO<sub>TD</sub>. <b>Methods:</b> This was a single-center retrospective study of consecutive patients (<i>n</i> = 151) who underwent right heart catheterization with CO<sub>TD</sub>, CO<sub>Fick</sub>, PAWPee, and PAWPav. A secondary cohort consisted of consecutive patients (<i>n</i> = 71) who had mean pulmonary artery pressure at end-expiration (mPAPee) and mPAP averaged across the respiratory cycle (mPAPav) measured, as well as PAWPee and PAWPav. <b>Results:</b> The PAWPee and PAWPav were 16.8 ± 6.4 and 15.1 ± 6.8 mm Hg, respectively, with a mean difference of 1.7 ± 2.1 mm Hg. The CO<sub>TD</sub> and CO<sub>Fick</sub> determinations were 5.0 ± 2.4 and 5.3 ± 2.5 L/min, respectively, with a mean difference of -0.4 ± 1.3 L/min. The hemodynamic group distribution was significantly different when using PAWPee versus PAWPav, when using either CO<sub>TD</sub> or CO<sub>Fick</sub> (<i>P</i> < 0.001 for both comparisons), and these results were consistent in our secondary cohort. The pulmonary hypertension hemodynamic group distribution was not significantly different between CO<sub>TD</sub> and CO<sub>Fick</sub> when using either PAWPee or PAWPav. <b>Conclusions:</b> The methodology used to measure PAWP, either at end-expiration or averaged across the respiratory cycle, significantly impacts the hemodynamic classification of pulmonary hypertension.</p>\",\"PeriodicalId\":8018,\"journal\":{\"name\":\"Annals of the American Thoracic Society\",\"volume\":\" \",\"pages\":\"1752-1759\"},\"PeriodicalIF\":6.8000,\"publicationDate\":\"2023-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of the American Thoracic Society\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1513/AnnalsATS.202303-216OC\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RESPIRATORY SYSTEM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of the American Thoracic Society","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1513/AnnalsATS.202303-216OC","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0
摘要
理由:指南推荐使用呼气末肺动脉压测量来确定肺动脉高压的血流动力学亚组。肺动脉楔压(PAWP)测定全呼吸周期平均值(PAWPav)而不是呼气末平均值(PAWPee)和心输出量(CO)测定菲克(COFick)而不是热稀释(COTD)可能影响肺动脉高压的血流动力学分类。目的:评价使用PAWPee与PAWPav、COFick与COTD对肺动脉高压血流动力学分级的影响。方法:这是一项单中心回顾性研究,对连续接受COTD、COFick、PAWPee和PAWPav右心导管插管的患者(n = 151)进行研究。第二个队列由连续患者(n = 71)组成,他们测量了呼气末平均肺动脉压(mPAPee)和呼吸周期平均肺动脉压(mPAPav),以及PAWPee和PAWPav。结果:PAWPee和PAWPav分别为16.8±6.4和15.1±6.8 mm Hg,平均差值为1.7±2.1 mm Hg。COTD和COFick分别为5.0±2.4和5.3±2.5 L/min,平均差值为-0.4±1.3 L/min。使用PAWPee与使用PAWPav、使用COTD或COFick时血流动力学组分布有显著差异(使用PAWPee或PAWPav时P TD和COFick)。结论:测量肺动脉高压的方法,无论是呼气末还是整个呼吸周期的平均值,都显著影响肺动脉高压的血流动力学分类。
Impact on Pulmonary Hypertension Hemodynamic Classification Based on the Methodology Used to Measure Pulmonary Artery Wedge Pressure and Cardiac Output.
Rationale: Guidelines recommend using end-expiration pulmonary pressure measurements to determine the hemodynamic subgroups in pulmonary hypertension. Pulmonary artery wedge pressure (PAWP) determinations averaged across the respiratory cycle (PAWPav) instead of PAWP at end-expiration (PAWPee) and cardiac output (CO) measured by Fick (COFick) instead of thermodilution (COTD) may affect the hemodynamic classification of pulmonary hypertension. Objectives: To assess the impact on the pulmonary hypertension hemodynamic classification of the use of PAWPee versus PAWPav as well as COFick versus COTD. Methods: This was a single-center retrospective study of consecutive patients (n = 151) who underwent right heart catheterization with COTD, COFick, PAWPee, and PAWPav. A secondary cohort consisted of consecutive patients (n = 71) who had mean pulmonary artery pressure at end-expiration (mPAPee) and mPAP averaged across the respiratory cycle (mPAPav) measured, as well as PAWPee and PAWPav. Results: The PAWPee and PAWPav were 16.8 ± 6.4 and 15.1 ± 6.8 mm Hg, respectively, with a mean difference of 1.7 ± 2.1 mm Hg. The COTD and COFick determinations were 5.0 ± 2.4 and 5.3 ± 2.5 L/min, respectively, with a mean difference of -0.4 ± 1.3 L/min. The hemodynamic group distribution was significantly different when using PAWPee versus PAWPav, when using either COTD or COFick (P < 0.001 for both comparisons), and these results were consistent in our secondary cohort. The pulmonary hypertension hemodynamic group distribution was not significantly different between COTD and COFick when using either PAWPee or PAWPav. Conclusions: The methodology used to measure PAWP, either at end-expiration or averaged across the respiratory cycle, significantly impacts the hemodynamic classification of pulmonary hypertension.
期刊介绍:
The Annals of the American Thoracic Society (AnnalsATS) is the official international online journal of the American Thoracic Society. Formerly known as PATS, it provides comprehensive and authoritative coverage of a wide range of topics in adult and pediatric pulmonary medicine, respiratory sleep medicine, and adult medical critical care.
As a leading journal in its field, AnnalsATS offers up-to-date and reliable information that is directly applicable to clinical practice. It serves as a valuable resource for clinical specialists, supporting their formative and continuing education. Additionally, the journal is committed to promoting public health by publishing research and articles that contribute to the advancement of knowledge in these fields.