title: Pulmonary artery occlusion pressure may overdiagnose pulmonary artery hypertension in sickle cell disease.
abstract: BACKGROUND
  A high prevalence of Pulmonary Hypertension (PH) in sickle cell disease (SCD) has been reported in several studies. However, few studies that describe the hemodynamics have actually measured pulmonary artery occlusive pressure (PAOP). Furthermore, even PAOP has been shown to be unreliable in discriminating pulmonary artery hypertension from pulmonary venous hypertension. We prospectively examined the accuracy of PAOP using simultaneous left ventricular end diastolic pressure (LVEDP) measurement as the gold standard.
  
  
  OBJECTIVE
  In patients with SCD, PAOP may not reflect LVEDP leading to over-diagnosis of PAH.
  
  
  METHODS
  We prospectively examined hemodynamic data on 26 patients with SCD, at a large academic center, from 2009 through 2011. These patients underwent simultaneous PAOP and LVEDP measurements.
  
  
  RESULTS
  We tested 106 adult SCD patients with 2-D Echocardiography for evaluation of PH. Of the 106 patients, 43 (41%) were found to have a tricuspid regurgitant jet velocity ≥ 2.5 m/sec. Of these 43, 26 patients underwent right heart catheterization (RHC) and simultaneous measurement of LVEDP. Twelve patients among the 106 (11.1%) patients were found to have PH. Eight of these (7.5 %) had PAH by PAOP criteria but only 4/106 (3/7%) had PAH by LVEDP criteria. PAOP significantly underestimated the LVEDP in both the PH group and group with normal hemodynamics (p=0.00004). BNP, and creatinine levels significantly increased in PAH group (p< 0.02, 0.01, 0.03). PAOP misclassified 50% of patients in this sickle cell disease cohort. In conclusion, PAOP may underestimate LVEDP in sickle cell patients with pulmonary hypertension and can lead to misclassification.
authors.affiliation: Thomas Jefferson University, Pulmonary and Critical Care Medicine, Jefferson Medical College, Philadelphia, Pennsylvania.
authors.forename: Sunil
authors.initials: S
authors.lastname: Sharma
authors.forename: Jimmy
authors.initials: J
authors.lastname: Efird
authors.forename: Renuka
authors.initials: R
authors.lastname: Kadali
authors.forename: Sanjay
authors.initials: S
authors.lastname: Mehra
authors.forename: Hadi
authors.initials: H
authors.lastname: Chohan
authors.forename: Ramesh
authors.initials: R
authors.lastname: Daggubati
authors.forename: Darla
authors.initials: D
authors.lastname: Liles
authors.forename: Catherine
authors.initials: C
authors.lastname: Gouge
authors.forename: Peter
authors.initials: P
authors.lastname: Boettger
authors.forename: Charles
authors.initials: C
authors.lastname: Knupp
mesh_terms: D000328:Adult; D000368:Aged; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000503:physiopathology; D006328:Cardiac Catheterization; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004452:Echocardiography; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D017725:Ventricular Pressure / Q000502:physiology*; D055815:Young Adult
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