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CLINICAL STUDY: PULMONARY HYPERTENSION

Pulmonary artery pulse pressure and wave reflection in chronic pulmonary thromboembolism and primary pulmonary hypertension

Vincent Castelain, MD^* , Philippe Hervé, MD^*, Yves Lecarpentier, MD, PhD , Pierre Duroux, MD^*, Gerald Simonneau, MD^* and Denis Chemla, MD, PhD

^* Service de Pneumologie, Hôpital Antoine Béclère, Université Paris-XI, Assistance Publique-Hôpitaux de Paris, Clamart, France
Service d’Explorations Fonctionnelles Cardio-Respiratoires, CHU de Bicêtre, Université Paris-XI, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
Inserm-Loa-Ensta-Ecole Polytechnique, Palaiseau, France

Manuscript received November 1, 1999; revised manuscript received November 27, 2000, accepted December 1, 2000.

Reprint requests and correspondence: Dr. Denis Chemla, Service d’Explorations Fonctionnelles Cardio-Respiratoires, Chu de Bicêtre, 94 275 Le Kremlin Bicêtre, France
denis.chemla{at}bct.ap-hop-paris.fr

OBJECTIVES

The purpose of this time-domain study was to compare pulmonary artery (PA) pulse pressure and wave reflection in chronic pulmonary thromboembolism (CPTE) and primary pulmonary hypertension (PPH).

BACKGROUND

Pulmonary artery pressure waveform analysis provides a simple and accurate estimation of right ventricular afterload in the time-domain. Chronic pulmonary thromboembolism and PPH are both responsible for severe pulmonary hypertension. Chronic pulmonary thromboembolism and PPH predominantly involve proximal and distal arteries, respectively, and may lead to differences in PA pressure waveform.

METHODS

High-fidelity PA pressure was recorded in 14 patients (7 men/7 women, 46 ± 14 years) with CPTE (n = 7) and PPH (n = 7). We measured thermodilution cardiac output, mean PA pressure (MPAP), PA pulse pressure (PAPP = systolic – diastolic PAP) and normalized PAPP (nPAPP = PPAP/MPAP). Wave reflection was quantified by measuring Ti, that is, the time between pressure upstroke and the systolic inflection point (Pi), P, that is, the systolic PAP minus Pi difference, and the augmentation index (P/PPAP).

RESULTS

At baseline, CPTE and PPH had similar cardiac index (2.4 ± 0.4 vs. 2.5 ± 0.5 l/min/m²), mean PAP (59 ± 9 vs. 59 ± 10 mm Hg), PPAP (57 ± 13 vs. 53 ± 13 mm Hg) and nPPAP (0.97 ± 0.16 vs. 0.89 ± 0.13). Chronic pulmonary thromboembolism had shorter Ti (90 ± 17 vs. 126 ± 16 ms, p < 0.01) and higher P/PPAP (0.26 ± 0.01 vs. 0.09 ± 0.07, p < 0.01).

CONCLUSIONS

Our study indicated that: 1) CPTE and PPH with severe pulmonary hypertension had similar PA pulse pressure, and 2) wave reflection is elevated in both groups, and CPTE had increased and anticipated wave reflection as compared with PPH, thus suggesting differences in the pulsatile component of right ventricular afterload.

Abbreviations and Acronyms   b.s.a. = body surface area   CPTE = chronic pulmonary thromboembolism   DPAP = diastolic pulmonary artery pressure   dP/dt = pressure derivative   MPAP = mean pulmonary artery pressure   PA = pulmonary artery   PAPP = pulmonary artery pulse pressure   PPH = primary pulmonary hypertension   SPAP = systolic pulmonary artery pressure   TPR = total pulmonary resistance

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