Right ventricular wave reflection relate to clinical measures in pulmonary arterial hypertension

OBJECTIVES: When a forward running pressure wave from the right ventricle reaches the narrow vessels in the pulmonary circulation, it is reflected as a backward running wave. We aimed to relate changes in right ventricular waveform reflection (RVWR) to changes in clinical variables in pulmonary arterial hypertension (PAH) patients. DESIGN: Twenty-one PAH patients with RV waveform recordings from two sequential catheterisations at least 6 months apart were included. Six-minute walked distance (6MWD) and brain natriuretic peptide (BNP) level were also available. RVWR was defined as 'the pressure from the inflection point on the upstroke RV pressure wave to RV peak pressure'. Direction of change in RVWR, 6MWD and BNP was classified as (+) if increased and (-) if decreased. Spearman correlations were used to analyse the relation between changes. Pearson's correlation coefficient was used to analyse relation between RVWR and pulmonary vascular resistance (PVR). RESULTS: The correlation between change in RVWR and 6MWD was - 0.67 (p < 0.01) and between RVWR and BNP was - 0.53 (p < 0.05). Actual RVWR and PVR correlated both at first (0.56, p < 0.001) and at second right heart catheterisation (0.45, p < 0.001). CONCLUSION: RVWR might have clinical implications indicating a change in clinical status and disease progression in patients with PAH.