Effect of balloon inflation volume on pulmonary artery occlusion pressure in patients with and without pulmonary hypertension.
BACKGROUND
Pulmonary artery occlusion pressure (PAOP) is used to differentiate patients with pulmonary hypertension (PH) associated with left-sided heart disease from other etiologies. Technical errors in the measurement of PAOP are common and lead to incorrect classification of the etiology of PH. We investigated the agreement among PAOP measurements obtained from both pulmonary arteries with balloon full (1.5 mL) and half (0.75 mL) inflation in patients undergoing right-sided heart catheterization for suspected PH.


METHODS
Thirty-seven patients suspected or known to have PH who underwent right-sided heart catheterization were included. Seventy-six percent had PH (mean pulmonary arterial pressure > 25 mm Hg). The validity of the measurements was assessed by using five preestablished criteria based on hemodynamic, fluoroscopic, and gasometric data. For each patient, the measurement that most likely represented the left atrial pressure was labeled "best PAOP."


RESULTS
Seventy percent of all the PAOP measurements met at least four of the five preestablished criteria for validity. In patients with PH (n = 28), the mean ± SE PAOP was 23.1 ± 2 and 19.1 ± 2 mm Hg for balloon full and half inflation, respectively, in the right pulmonary artery and 23.54 ± 2 and 19.07 ± 2 mm Hg for balloon full and half inflation, respectively, in the left pulmonary artery (P = .05). Bland-Altman analysis revealed lower bias and narrower limits of agreement with balloon half inflation. Wedge angiography showed that some balloon inflations failed to occlude upstream flow, whereas others had collateral vessels draining after the occlusion.


CONCLUSIONS
PAOP can be falsely elevated in patients with PH according to the balloon inflation volume. Balloon half inflation was safe and correlated with higher precision and lower bias in the PAOP measurements.
Tonelli
Adriano R
AR
Pulmonary Vascular Disease Program, University of Florida, Gainesville, FL, USA. Adriano.Tonelli@medicine.ufl.edu
Mubarak
Kamal K
KK
Li
Ning
N
Carrie
Robin
R
Alnuaimat
Hassan
H
D002404:Catheterization / Q000379:methods*; D002405:Catheterization, Central Venous; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000503:physiopathology*; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012189:Retrospective Studies