Right heart catheterization procedures in patients with suspicion of pulmonary hypertension - experiences of a tertiary center (original) (raw)
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2021
Purpose: Studies in the context of research have shown a significant disagreement between the echocardiographic measurement of the systolic pulmonary artery pressure (sPAP) and right atrial pressure (RAP) and that obtained by right heart catheterization (RHC). We compare measurements of sPAP and RAP, verified by transthoracic echocardiogram (TTE) with those detected by RHC in patients being investigated for pulmonary hypertension (PH). Methods: Cross-sectional study was performed in a context of usual clinical practice in the public referral center for PH, including patients with high or intermediate echocardiographic probability of pulmonary arterial hypertension and chronic thromboembolic PH. Bland-Altman test was used to assess the agreement amongthe values and ROC curve to identify sPAP and tricuspid regurgitation velocity (TRV) values with better accuracy. Clinically acceptable differences of 10 mmHg for sPAP and 5 mmHg for RAP were considered.Results: Ninety-five patients we...
Background: Anaesthetists and other clinicians depend on echocardiographic estimation of pulmonary artery pressures for clinical decisions in cardiac patients. Our objective was to compare the systolic pulmonary arterial pressures estimated by echocardiography to that measured by right heart catheterisation. Patients and Methods: This was a retrospective-prospective analytical study of all patients referred for right heart catheterization (RHC) between 1st January 2006 and 31st March 2010. The echocardiographic (Echo) estimation of the systolic pulmonary artery pressures was compared to the systolic pulmonary artery pressures measured during right heart catheterization. Results: There were 64 patients, 37 (57.8%) were female, 27(42.2%) male. Twenty (31.3%) were between 11-20 years and 13 (20.3%) were 31-40 years. The youngest patient was 3 years old and the oldest 68 years. The Echo diagnosis was ASD, VSD, and Pulmonary Arterial Hypertension in 32.8%, 21.9% and 12.9% respectively. T...
International Journal of Advances in Medicine
Background: Definitive diagnosis of pulmonary artery hypertension (PH) requires an elevated mean pulmonary arterial pressure (MPAP) of 25 mmHg at rest measured by right heart catheterization (RHC). As it is invasive mode of investigation, it is declined by many patients, echocardiography was thought to be an acceptable substitute to assess pulmonary arterial pressures. Whether there is a correlation between these measurements is controversial. The aim of this study was to assess PH by echocardiography and its correlation with RHC.Methods: Twenty-six patients aged ≥18 years with pulmonary artery hypertension with or without tricuspid regurgitation (TR) were included in this cross-sectional study. All the patients underwent a transthoracic echocardiography evaluation and were taken for RHC study within an hour.Results: The correlation between pulmonary artery acceleration time (PAAT) and pulmonary artery systolic pressure (PASP) and PAAT and MPAP was significant in all degrees of PH. ...
Mædica, 2013
Pulmonary arterial hypertension (PAH) represents an emerging pathology in modern medicine. Transthoracic echocardiography is an inexpensive and reproducible method and it is the most commonly used non-invasive diagnostic tool to asses pulmonary artery pressure (PAP) and the function of the right ventricle. Although, the right heart catheterization is still considered as the standard for the diagnosis, according to the last guidelines, the new echocardiographic methods may offer an improved value in the PAH evaluation. To evaluate if cardiac ultrasonography data correlate with catheterization results in patients with PAH (Group I Dana Point 2008), and to compare the ultrasonography evaluation of PAH patients with that of normal. 15 consecutive patients (pts) (52±15 yrs, 5 men, time from onset of symptoms 1.6±1.7 years) with PAH of different aetiologies (12 pts with idiopathic PAH, 2 pts with PAH associated with scleroderma and one with persistent PAH after atrial septal defect (ASD) ...
Pulmonary Circulation, 2019
Background The diagnosis of pulmonary arterial hypertension requires right heart catheterization (RHC) which is typically performed via proximal venous access (PVA). Antecubital venous access (AVA) is an alternative approach for RHC that can minimize complications, decrease procedural duration and allow for immediate patient recovery. A direct comparison between the two procedures in patients with pulmonary hypertension (PH) is lacking. Objectives To determine the feasibility, safety, and adoption rates of AVA-RHC as compared with ultrasound-guided PVA in a subpopulation of patients with PH. Methods All patients who underwent RHC for evaluation of PH between December 2014 and March 2017 at a single large academic medical center were included in this study. Demographic, procedural and outcomes data were retrieved from the medical records. Results In total, 159 RHC were included (124 AVA, 35 PVA). The duration of RHC was significantly shorter in the AVA compared with PVA group (53 (IQ...
Materia Socio Medica, 2011
Pressure (PAP) ≥ 25mmHg at rest as sessed by right heart catheterization (RHC). Objective and purpose: The objective of this study is to determine, by investigating haemodynamic parameters of the pulmonary hypertension in congenital and left heart diseases, the linkage and diagnostic value of echocardiography in detecting the pulmonary hypertension in heart diseases and assessing its degree, as well as to warrant a wider application of this non-invasive diagnostic method. Patients and methods: The research covered 56 adult subjects of both genders, who were subjected to echocardiography as part of the clinical cardiological examination. The patients were examined on an ultrasound machine ATL HDI-3000 and 5000, equipped with a cardiologic probe for adults 2.25 MHz and a multi-plan transoesophageal probe ATL MPT7-4 TEE. The patients, for whom invasive cardiologic diagnostic methods were indicated following evaluation by echocardiography, were subjected to cardiac catheterization. RHC was performed in all patients and diagnosis of pulmonary hypertension was established by measuring mean PAP ≥ 25mmHg at rest, also left heart catheterization was performed in order to define the underlying heart disease. The haemodynamic parameters, obtained for each method applied, have been statistically processed. Results: By the statistical processing of the echocardiographic parameters a correlation ratio has been found, which shows significant correlation between the non-invasive variables (AcT, Act/RVET, PEP/AcT, PEP/RVET and RVSP according to modified Bernoulli equation. MPAP according to Mahan's equation, SPAP according to Berger's equation) and the variables obtained by right heart catheterization (RHC): (RVSP, MPAP, SPAP): a) In AcT and AcT/RVET variables, a negative correlation was found AcT r = -0.936, Standard Estimation Error (SEE) = 5.53, p <0.001. AcT/RVET r = -0.896, SEE = 6.96, p <0.001; b) while positive correlation was found in variables PEP/AcT r = 0.915, SEE = 6.36, p <0.001 and PEP/RVET r = 0.917, SEE = 6.26, p <0.001; c) MPAP obtained by echocardiography (calculated by applying Mahan's equation) V.S. MPAP obtained by right heart catheterization r = 0.936, SEE = 5.53 mmHg; d) SPAP obtained by echocardiography (calculated by applying Berger's equation) V.S. SPAP obtained by right heart catheterization r = 0.971, SEE = 5.72 mmHg; e) RVSP obtained by echocardiography (calculated by applying a modified Bernoulli's equation) V.S. RVSP obtained by right heart catheterization r = 0.882, SEE = 9.399 mmHg; f) RVSP obtained by echocardiography (calculated by applying a modified Bernoulli's equation) V.S. SPAP obtained by RHC r = 0.972, SEE = 5.60 mmHg. Conclusion:
2013
Background: Echocardiographic studies have contributed to progress in the understanding of the pathophysiology of the pulmonary circulation and have been shown to be useful for screening for and prognostication of pulmonary hypertension, but are considered unreliable for the diagnosis of pulmonary hypertension. We explored this apparent paradox with rigorous Bland and Altman analysis of the accuracy and the precision of measurements collected in a large patient population. Methods: A total of 161 patients referred for a suspicion of pulmonary hypertension were prospectively evaluated by a Doppler echocardiography performed by dedicated cardiologists within 1 h of an indicated right heart catheterization. Results: Nine of the patients (6%) were excluded due to an insufficient signal quality. Of the remaining 152 patients, 10 (7%) had no pulmonary hypertension and most others had either pulmonary arterial hypertension (36%) or pulmonary venous hypertension (40%) of variable severities. Mean pulmonary artery pressure, left atrial pressure and cardiac output were nearly identical at echocardiography and catheterization, with no bias and tight confidence intervals, respectively ± 3 mm Hg, ± 5 mm Hg and ±0.3 L/min. However, the ± 2SD limits of agreement were respectively of +19 and − 18 mm Hg for mean pulmonary artery pressure, + 8 and − 12 mm Hg for left atrial pressure and + 1.8 and − 1.7 L/min for cardiac output. Conclusions: Doppler echocardiography allows for accurate measurements of the pulmonary circulation, but with moderate precision, which explains why the procedure is valid for population studies but cannot be used for the individual diagnosis of pulmonary hypertension.
Left ventricular dysfunction in patients with suspected pulmonary arterial hypertension
Jornal Brasileiro de Pneumologia, 2014
Objective: To evaluate the role of right heart catheterization in the diagnosis of pulmonary arterial hypertension (PAH). Methods: We evaluated clinical, functional, and hemodynamic data from all patients who underwent right heart catheterization because of diagnostic suspicion of PAH-in the absence of severe left ventricular dysfunction (LVD), significant changes in pulmonary function tests, and ventilation/perfusion lung scintigraphy findings consistent with chronic pulmonary thromboembolism-between 2008 and 2013 at our facility. Results: During the study period, 384 patients underwent diagnostic cardiac catheterization at our facility. Pulmonary hypertension (PH) was confirmed in 302 patients (78.6%). The mean age of those patients was 48.7 years. The patients without PH showed better hemodynamic profiles and lower levels of B-type natriuretic peptide. Nevertheless, 13.8% of the patients without PH were categorized as New York Heart Association functional class III or IV. Of the 218 patients who met the inclusion criteria, 40 (18.3%) and 178 (81.7%) were diagnosed with PH associated with LVD (PH-LVD) and with PAH, respectively. The patients in the HP-LVD group were significantly older than were those in the PAH group (p < 0.0001). Conclusions: The proportional difference between the PAH and PH-LVD groups was quite significant, considering the absence of echocardiographic signs suggestive of severe LVD during the pre-catheterization investigation. Our results highlight the fundamental role of cardiac catheterization in the diagnosis of PAH, especially in older patients, in whom the prevalence of LVD that has gone undiagnosed by non-invasive tests is particularly relevant.
The importance of right ventricular function in patients with pulmonary arterial hypertension
Expert Review of Respiratory Medicine, 2018
Introduction: Pulmonary arterial hypertension (PAH) is a progressive, lifethreatening, and incurable disease. Prognosis is based on right ventricular (RV) function. Therefore, adequate assessment of RV function is mandatory. Areas covered: This article presents the case of a patient with PAH in which the traditional diagnostic approach did not provide a complete assessment of RV function. The authors show how the analysis of other parameters yielded additional information that improved the management of this patient. Expert commentary: Despite current treatments, PAH often worsens owing to progressive RV dysfunction. Appropriate assessment of RV function may facilitate the early identification of patients at risk of RV function impairment. More aggressive treatment of PAH might delay progression of the disease. Traditional risk stratification, which is based on NYHA/WHO functional class evaluation, the 6minute walk test, and right heart catheterization, proves insufficient in many PAH patients, as it does not provide complete information about RV function. Thus, further parameters are required. Analysis of RV function combined with echocardiography and cardiopulmonary exercise testing, may add relevant prognostic information and improve therapy.
Advances in clinical and experimental medicine : official organ Wroclaw Medical University
Pulmonary hypertension (PH), second only to left heart diseases (LHD), is a frequent problem in clinical practice. At the same time, left heart diseases represent the most common cause of pulmonary hypertension, and the occurrence of PH in patients with chronic heart failure is usually associated with worse functional class, and prognosis. Right heart catheterization (RHC) is the "gold standard" in the diagnosis and differentiation of PH. It is also essential in the process of qualifying for a heart transplantation. Therefore, right heart catheterization should be performed in expert centers by experienced operators and according to a strict protocol to ensure the reliability and reproducibility of results. Recommendations for pulmonary hypertension due to left heart disease are based on the European Society of Cardiology (ESC) guidelines designed in cooperation with the European Respiratory Society (ERS) and the International Society for Heart and Lung Transplantation (IS...