Central venous blood oxygen saturation monitoring in patients with chronic pulmonary arterial hypertension treated with continuous IV epoprostenol: correlation with measurements of hemodynamics and plasma brain natriuretic peptide levels.
BACKGROUND
IV epoprostenol is a highly effective therapy for pulmonary arterial hypertension (PAH). However, monitoring the efficacy and adjusting the dose of epoprostenol often requires serial invasive hemodynamic measurements. This study investigated whether superior vena cava (SVC) oxygen saturation measured from the indwelling catheter and brain natriuretic peptide (BNP) level would predict right heart catheterization markers associated with lower survival rates (right atrial pressure [RAP], > 10 mm Hg; pulmonary artery [PA] oxygen saturation, < 62%) in epoprostenol-treated patients with PAH.


METHODS
Twenty-seven epoprostenol-treated PAH patients had a BNP level and SVC oxygen saturation measured from their indwelling central venous catheters. The results were compared with cardiac catheterization results.


RESULTS
SVC oxygen saturation and BNP level both showed significant correlation with hemodynamic variables. BNP level correlated best with RAP (r = 0.66; p < 0.001), while SVC oxygen saturation correlated most closely with PA oxygen saturation (r = 0.91; p < 0.001). All patients with a BNP level of >or= 117 pg/mL had an elevated RAP (specificity, 100% [defined as a RAP of > 10 mm Hg]), but sensitivity was only 65%. An SVC oxygen saturation of < 64% showed a sensitivity of 89% and a specificity of 78% in predicting a PA oxygen saturation of < 62%.


CONCLUSIONS
SVC oxygen saturation and BNP level predict hemodynamics associated with lower survival rates and may be useful as "noninvasive" markers of prognosis in epoprostenol-treated PAH patients. BNP levels have a lower sensitivity relative to specificity, and a normal BNP level did not exclude a high RAP or low PA oxygen saturation.
Chin
Kelly M
KM
Department of Internal Medicine, University of Texas Southwestern Pulmonary Hypertension Program, 5909 Harry Hines Blvd, Dallas, TX 75235-9254, USA. kelly.chin@utsouthwestern.edu
Channick
Richard N
RN
Kim
Nick H
NH
Rubin
Lewis J
LJ
D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001784:Blood Gas Analysis; D006328:Cardiac Catheterization; D002302:Cardiac Output / Q000502:physiology; D002405:Catheterization, Central Venous; D011464:Epoprostenol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D007262:Infusions, Intravenous; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010100:Oxygen / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000502:physiology*; D011669:Pulmonary Wedge Pressure / Q000502:physiology
D000959:Antihypertensive Agents; D020097:Natriuretic Peptide, Brain; D011464:Epoprostenol; D010100:Oxygen