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Determinants and prognostic implications of the negative diastolic pulmonary pressure gradient in patients with pulmonary hypertension due to left heart disease.
- Source :
- European Journal of Heart Failure; Jan2017, Vol. 19 Issue 1, p88-97, 10p, 4 Charts, 2 Graphs
- Publication Year :
- 2017
-
Abstract
- <bold>Aims: </bold>The diastolic pulmonary pressure gradient (DPG) has recently been introduced as a specific marker of combined pre-capillary pulmonary hypertension (Cpc-PH) in left heart disease (LHD). However, its diagnostic and prognostic superiority compared with traditional haemodynamic indices has been challenged lately. Current recommendations explicitly denote that in the normal heart, DPG values are greater than zero, with DPG ≥7 mmHg indicating Cpc-PH. However, clinicians are perplexed by the frequent observation of DPG <0 mmHg (DPGNEG ), as its physiological explanation and clinical impact are unclear to date. We hypothesized that large V-waves in the pulmonary artery wedge pressure (PAWP) curve yielding asymmetric pressure transmission might account for DPGNEG and undertook this study to clarify the physiological and prognostic implications of DPGNEG .<bold>Methods and Results: </bold>Right heart catheterization and echocardiography were performed in 316 patients with LHD due to primary myocardial dysfunction or valvular disease. A total of 256 patients had PH-LHD, of whom 48% demonstrated DPGNEG . The V-wave amplitude inversely correlated with DPG (r = -0.45, P < 0.001) in patients with low pulmonary vascular resistance (PVR), but not in those with elevated PVR (P > 0.05). Patients with large V-waves had negative and lower DPG than those without augmented V-waves (P < 0.001) despite similar PVR (P >0.05). Positive, but normal DPG (0-6 mmHg) carried a worse 2-year prognosis for death and/or heart transplantation than DPGNEG (hazard ratio 2.97; P < 0.05).<bold>Conclusion: </bold>Our results advocate against DPGNEG constituting a measurement error. We propose that DPGNEG can partially be ascribed to large V-waves and carries a better prognosis than DPG within the normal positive range. [ABSTRACT FROM AUTHOR]
- Subjects :
- PULMONARY hypertension diagnosis
DIASTOLE (Cardiac cycle)
ECHOCARDIOGRAPHY
LEFT heart ventricle diseases
HEMODYNAMICS
PULMONARY artery physiology
HEART ventricle diseases
BLOOD pressure
CARDIAC catheterization
LEFT heart ventricle
HEART transplantation
HEART failure
LONGITUDINAL method
VASCULAR resistance
MORTALITY
PROGNOSIS
PULMONARY hypertension
DISEASE complications
Subjects
Details
- Language :
- English
- ISSN :
- 13889842
- Volume :
- 19
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- European Journal of Heart Failure
- Publication Type :
- Academic Journal
- Accession number :
- 120534231
- Full Text :
- https://doi.org/10.1002/ejhf.675