The relationship between pulmonary artery and pulmonary capillary wedge pressure for the diagnosis of pulmonary vascular disease.
BACKGROUND
Left heart disease and pulmonary vascular disease (PVD) both lead to raised pulmonary artery pressure (PAP) but differ in pathophysiology, prognosis and treatment. There are currently no criteria for diagnosing PVD in the presence of left heart disease. We therefore studied the relationship between PAP and pulmonary capillary wedge pressure (PCWP, a measure of left atrial pressure) to help define when PAP should be considered 'out-of-proportion' to PCWP, thus suggestive of PVD.


METHODS
Retrospective analysis of 898 consecutive simultaneous left and right heart catheterisations. Of these, 684 patients (age 63+/-14 years) were classified according to presence of absence of left heart disease. Multilinear regression explored the relationship between mean PAP and PCWP, age, gender, systemic haemodynamics and left heart disease diagnosis.


RESULTS
Increasing PCWP, age and heart rate and female gender were associated with higher PAP (p<0.0001, p=0.049, p<0.0001 and p=0.0015, respectively). Thus, in males: (mean PAP)=0.94+[1.15 x (mean PCWP)]+[0.03 x (age)]+[0.07 x (heart rate)] (for females add 1.38 mm Hg). This model accounted for 75% of variability in PAP, with PCWP alone accounting for 74%.


CONCLUSIONS
A strong linear relationship exists between PAP and PCWP, which may help identify PAP 'out-of-proportion' to PCWP, facilitating the diagnosis of PVD in patients with pulmonary hypertension and left heart disease.
Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, New South Wales 2050, Australia. rilsar@gmail.com
Rahn
R
Ilsar
Brian P
BP
Bailey
Timothy A
TA
Dobbins
David S
DS
Celermajer
D006328:Cardiac Catheterization; D009202:Cardiomyopathies / Q000150:complications* / Q000175:diagnosis; D016001:Confidence Intervals; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications* / Q000175:diagnosis; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis; D011379:Prognosis; D011651:Pulmonary Artery / Q000503:physiopathology*; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D012307:Risk Factors