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Pulm Circ. 2019;9(1):2045894019833352.

Clinical implication of right-sided augmentation pressure in patients with pulmonary hypertension.

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제1저자 손대원 · 교신저자 손대원

소속 (1)
  1. Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.

Abstract

Similar to left ventricular and aortic pressure waveforms, augmentation pressure (AugPr) in the right ventricular (RV) pressure waveform is also frequent in patients with pulmonary hypertension (PH). This study sought to evaluate whether the degree of AugPr in RV pressure waveform has prognostic value. Forty-one patients (13 men; mean age = 50.7 ± 16.1 years) with group 1 PH (mean pulmonary artery pressure [mPAP] ≥ 25 mmHg) who underwent cardiac catheterization as part of their work-up were retrospectively enrolled. Patients were divided into three groups. Group A: AugPr/RV systolic pressure < 25%; group B: AugPr/RV systolic pressure ≥ 25%; and group C: no discernible AugPr but showing peaked RV pressure waveform. Ten patients were included in group A (male-to-female ratio 3:7; mean age = 45.9 ± 12.1 years), 12 in group B (4:8, 53.8 ± 14.6 years), and 19 in group C (6:13, 51.8 ± 18.7 years). No differences in mPAP were seen between the three groups. Pulse pressure was significantly higher in group C compared to group A. Eight patients died during the mean follow-up period of 35.9 ± 30.7 months; the incidence of death was significantly higher in group C than in the other groups (one patient in group A and seven patients in group C). AugPr in RV pressure waveform has prognostic value in patients with PH. Therefore, additional attention should be given to the RV pressure waveform in patients with PH undergoing invasive pressure measurements as a part of their work-up.

Keywords

augmentation pressureprognosispulmonary hypertension

Figures

Fig. 1.
Fig. 1. Representative RV pressure wave forms in groups A, B, and C. (a) Group A = patients with AugPr/RVSP ratio < 25%; (b) Group B = patients with AugPr/RVSP of ≥ 25%; (c) Group C = patients without discernible inflected point on the ascending limb of the RV waveform, but showing peaked waveform. AugPr, augmentation pressure; RVSP, right ventricular systolic pressure; RV, right ventricle.
Fig. 2.
Fig. 2. RV pressures in patients with a positive response to vasodilator at baseline (a) and following nitroprusside infusion (b). The difference between peak RVSP and pressure at the inflection point was 12 mmHg and the peak RVSP decreased from 70 mmHg to 45 mmHg. RV pressures in patients without a positive response to vasodilator at the baseline (c) and following nitroprusside infusion (d). The difference between peak RVSP and the pressure at the inflection point was 23 mmHg; the peak RVSPs were the same before and after nitroprusside infusion. Pressures are measured with Millar catheter. Ao, aortic pressure; RV, right ventricular pressure (Reprinted with permission by Korean Circulation Journal).
Fig. 3.
Fig. 3. Difference in PA pulse pressure in patients with Group A (a) and Group C (b).

그림 출처: PubMed Central 공개 논문 (PMC6388450)

그 밖의 정보
출판 형태
Journal Article
저널
Pulmonary circulation · ISSN 2045-8932
참고문헌
11편