Chronic pulmonary thromboembolism was associated with shorter Ti (90 vs 126 ms, p<0.01) and higher augmentation index (0.26 vs 0.09, p<0.01) compared to primary pulmonary hypertension.
Observational (n=14)
Does high-fidelity pulmonary artery pressure waveform analysis reveal differences in wave reflection between patients with chronic pulmonary thromboembolism and primary pulmonary hypertension?
Wave reflection is increased and occurs earlier in chronic pulmonary thromboembolism compared to primary pulmonary hypertension, indicating differences in the pulsatile component of right ventricular afterload despite similar mean pulmonary pressures.
Absolute Event Rate: 90% vs 126%
p-value: p=<0.01
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), deltaP, that is, the systolic PAP minus Pi difference, and the augmentation index (deltaP/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 deltaP/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.
Castelain et al. (Thu,) conducted a observational in Chronic pulmonary thromboembolism and primary pulmonary hypertension (n=14). Chronic pulmonary thromboembolism vs. Primary pulmonary hypertension was evaluated on Ti (time between pressure upstroke and the systolic inflection point) (p=<0.01). Chronic pulmonary thromboembolism was associated with shorter Ti (90 vs 126 ms, p<0.01) and higher augmentation index (0.26 vs 0.09, p<0.01) compared to primary pulmonary hypertension.