Does monitoring both pulmonary vascular resistance and compliance better explain changes in cardiac index during treatment in patients with pulmonary hypertension?
Pulmonary arterial compliance and resistance remain inversely related during pulmonary hypertension treatment, and monitoring both provides a better assessment of hemodynamic improvement than resistance alone.
Pulmonary arterial compliance (C) is increasingly being recognized as an important contributor to right ventricular afterload, but for monitoring of treatment of pulmonary hypertension (PH) most often still only pulmonary vascular resistance (R) is used. We aimed at testing the hypothesis that R and C are coupled during treatment of PH and that substantial changes in both R and C would result in more haemodynamic improvement than changes in R alone. Data were analysed of two right-heart catheterizations of 52 patients with pulmonary arterial hypertension and 10 with chronic-thromboembolic PH. The product of R and C (= stroke volume over pulse pressure) did not change during therapy (P = 0.320), implying an inverse relationship. Changes in cardiac index correlated significantly (P < 0.001) with changes in R (R2 = 0.37), better with changes in C (R2 = 0.66), and best with changes in both (R2 = 0.74). During therapy for PH, R and C remain inversely related. Therefore, changes in both R and C better explain changes in cardiac index than either of them alone. Not only resistance but also compliance plays a prominent role in PH especially in an early stage of the disease.
Lankhaar et al. (Wed,) studied this question.