Characteristics of pulmonary artery pressure waveform for differential diagnosis of chronic pulmonary thromboembolism and primary pulmonary hypertension

Department of Cardiopulmonary Medicine, National Cardiovascular Center, Suita, Osaka, Japan.

OBJECTIVES: The accurate diagnosis of chronic pulmonary thromboembolism (CPTE) is a prerequisite for life-saving surgical interventions. To help in the differential diagnosis of CPTE and primary pulmonary hypertension (PPH), we characterized the configuration of the pulmonary artery pressure waveform. BACKGROUND: Because CPTE predominantly involves the proximal arteries, whereas PPH involves the peripheral arteries, we hypothesized that patients with CPTE would have stiff or high resistance proximal arteries, whereas those affected by PPH would have high resistance peripheral arteries. These differences in the primary lesions would make arterial pulsatility relative to mean pressure larger in CPTE than in PPH. METHODS: In 34 patients with either CPTE (n = 22) or PPH (n = 12) whose pulmonary systolic pressure was > or = 50 mm Hg, we measured pulmonary artery pressure using a fluid-filled system that included a balloon-tipped flow-directed catheter. RESULTS: To quantify the magnitude of pulsatility relative to mean pressure, we normalized pulse pressure by mean pressure, hereinafter referred to as fractional pulse pressure (PPf). PPf was markedly higher in CPTE than in PPH (mean [+/-SD] 1.41 +/- 0.20 and 0.80 +/- 0.18, respectively, p < 0.001) and was diagnostic in separating the two groups without overlap. Similarly, the coefficient of variation of pulmonary artery pressure also separated the two groups without overlap (0.45 +/- 0.06 and 0.25 +/- 0.06, respectively, p < 0.001). Fractional time to half the area under the pressure curve separated the two groups reasonably well (0.35 +/- 0.02 and 0.43 +/- 0.03, respectively, p < 0.001). CONCLUSIONS: The analysis of pulsatility of pulmonary artery pressure is useful in the differential diagnosis of CPTE and PPH.

This article has been cited by other articles:

				Y. Ganushchak, K. Reesink, P. Weerwind, and J. Maessen The effect of oxygenator mechanical characteristics on energy transfer during clinical cardiopulmonary bypass Perfusion, January 1, 2011; 26(1): 39 - 44. [Abstract] [PDF]

				M. Delcroix, P. Dorfmuller, M. R. MacLean, J. A. Barbera, M. M. Hoeper, H. Ghofrani, S. Adnot, S. Eddahibi, S. Janssens, A. J. Peacock, et al. Pulmonary hypertension: future therapies Pulmonary Vascular Pathology: a Clinical Update, June 28, 2010; 84 - 109. [Abstract] [Fulltext] [PDF]

				R. Naeije and P. Dorfmuller Pathophysiology of pulmonary arterial hypertension Pulmonary Vascular Pathology: a Clinical Update, June 28, 2010; 191 - 203. [Abstract] [Fulltext] [PDF]

				S. Yasuno, K. Ueshima, K. Oba, A. Fujimoto, M. Hirata, T. Ogihara, T. Saruta, and K. Nakao Is Pulse Pressure a Predictor of New-Onset Diabetes in High-Risk Hypertensive Patients?: A subanalysis of the Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial Diabetes Care, May 1, 2010; 33(5): 1122 - 1127. [Abstract] [Full Text] [PDF]

				R. Naeije and S. Huez Right ventricular function in pulmonary hypertension: physiological concepts Eur. Heart J. Suppl., December 1, 2007; 9(suppl_H): H5 - H9. [Abstract] [Full Text] [PDF]

				R. Naeije and S. Huez Reflections on wave reflections in chronic thromboembolic pulmonary hypertension Eur. Heart J., April 1, 2007; 28(7): 785 - 787. [Full Text] [PDF]

				S. Ulrich, M. Fischler, R. Speich, V. Popov, and M. Maggiorini Chronic thromboembolic and pulmonary arterial hypertension share acute vasoreactivity properties. Chest, September 1, 2006; 130(3): 841 - 846. [Abstract] [Full Text] [PDF]

				A. Peacock, R. Naeije, N. Galie, and J.T. Reeves End points in pulmonary arterial hypertension: the way forward Eur. Respir. J., June 1, 2004; 23(6): 947 - 953. [Abstract] [Full Text] [PDF]

				S. Huez, S. Brimioulle, R. Naeije, and J.-L. Vachiery Feasibility of Routine Pulmonary Arterial Impedance Measurements in Pulmonary Hypertension Chest, June 1, 2004; 125(6): 2121 - 2128. [Abstract] [Full Text] [PDF]

				R. J. Roeleveld, A. Vonk-Noordegraaf, J. T. Marcus, J. G. F. Bronzwaer, K. M. J. Marques, P. E. Postmus, and A. Boonstra Effects of Epoprostenol on Right Ventricular Hypertrophy and Dilatation in Pulmonary Hypertension Chest, February 1, 2004; 125(2): 572 - 579. [Abstract] [Full Text] [PDF]

				D. Chemla, V. Castelain, P. Herve, Y. Lecarpentier, and S. Brimioulle Haemodynamic evaluation of pulmonary hypertension Eur. Respir. J., November 1, 2002; 20(5): 1314 - 1331. [Abstract] [Full Text] [PDF]

				Y. Nakayama Pulse wave reflection in pulmonary hypertension: Reply J. Am. Coll. Cardiol., February 20, 2002; 39(4): 744 - 744. [Full Text] [PDF]

				R. D'Souza, R.J. MacFadyen, F. Kerr, A. Peacock, and M.M. Steven Lessons to be learned: a case study approach A case study of the temporal onset of pulmonary hypertension with pre-existent cirrhotic portal hypertension Perspectives in Public Health, December 1, 2001; 121(4): 257 - 261. [Abstract] [PDF]

				Y. Nakayama, N. Nakanishi, T. Hayashi, N. Nagaya, F. Sakamaki, N. Satoh, H. Ohya, and S. Kyotani Pulmonary artery reflection for differentially diagnosing primary pulmonary hypertension and chronic pulmonary thromboembolism J. Am. Coll. Cardiol., July 1, 2001; 38(1): 214 - 218. [Abstract] [Full Text] [PDF]

				N. Tanabe, O. Okada, Y. Abe, M. Masuda, N. Nakajima, and T. Kuriyama The influence of fractional pulse pressure on the outcome of pulmonary thromboendarterectomy Eur. Respir. J., April 1, 2001; 17(4): 653 - 659. [Abstract] [Full Text] [PDF]

				V. Castelain, P. Herve, Y. Lecarpentier, P. Duroux, G. Simonneau, and D. Chemla Pulmonary artery pulse pressure and wave reflection in chronic pulmonary thromboembolism and primary pulmonary hypertension J. Am. Coll. Cardiol., March 15, 2001; 37(4): 1085 - 1092. [Abstract] [Full Text] [PDF]

				H. Imanaka, H. Miyano, M. Takeuchi, K. Kumon, and M. Ando Effects of Nitric Oxide Inhalation After Pulmonary Thromboendarterectomy for Chronic Pulmonary Thromboembolism Chest, July 1, 2000; 118(1): 39 - 46. [Abstract] [Full Text] [PDF]

				Y. Nakayama, K. Tsumura, N. Yamashita, K. Yoshimaru, and T. Hayashi Pulsatility of Ascending Aortic Pressure Waveform Is a Powerful Predictor of Restenosis After Percutaneous Transluminal Coronary Angioplasty Circulation, February 8, 2000; 101(5): 470 - 472. [Abstract] [Full Text] [PDF]