title: Pulmonary artery reflection for differentially diagnosing primary pulmonary hypertension and chronic pulmonary thromboembolism.
abstract: OBJECTIVE
  The purpose of this investigation was to differentiate chronic pulmonary thromboembolism (CPTE) from primary pulmonary hypertension (PPH) by means of the indexes of pulmonary arterial reflection.
  
  
  BACKGROUND
  These differences in the primary lesions would make pulmonary artery reflection occur earlier in CPTE than in PPH. Although the analysis of pulsatility of pulmonary arterial pressure is useful in the differential diagnosis of PPH and CPTE, it is not known whether the analysis of pulmonary artery reflection can differentiate CPTE from PPH.
  
  
  METHODS
  Since CPTE predominantly involves the proximal arteries, whereas PPH involve the peripheral arteries, we hypothesized that patients with CPTE have a large augmentation index and a short inflection time. For this study, we enrolled 62 patients who had CPTE (31 patients) and PPH (31 patients). We measured pulmonary arterial pressure using a fluid filled system that included a balloon-tipped flow directed catheter. To quantify the pulmonary artery reflection, we used the augmentation index and inflection time.
  
  
  RESULTS
  The augmentation index was markedly higher in CPTE than it was in PPH (27.4% +/- 15.2% [SD] and -25.1% +/- 26.9%, respectively, p < 0.001) and was diagnostic in separating the two groups. Inflection time separated the two groups reasonably well (97 +/- 20 ms and 210 +/- 49 ms, respectively, p < 0.001).
  
  
  CONCLUSIONS
  The analysis of pulmonary arterial reflection is useful in the differential diagnosis of CPTE and PPH.
authors.affiliation: Department of Cardiology, Ishikiriseiki Hospital, Osaka, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Nakayama
authors.forename: N
authors.initials: N
authors.lastname: Nakanishi
authors.forename: T
authors.initials: T
authors.lastname: Hayashi
authors.forename: N
authors.initials: N
authors.lastname: Nagaya
authors.forename: F
authors.initials: F
authors.lastname: Sakamaki
authors.forename: N
authors.initials: N
authors.lastname: Satoh
authors.forename: H
authors.initials: H
authors.lastname: Ohya
authors.forename: S
authors.initials: S
authors.lastname: Kyotani
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002908:Chronic Disease; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000503:physiopathology*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014655:Vascular Resistance