title: Usefulness of pulmonary capillary wedge pressure as a correlate of left ventricular filling pressures in pulmonary arterial hypertension.
abstract: BACKGROUND
  Pulmonary arterial hypertension (PAH) is characterized by a pulmonary capillary wedge pressure (PCWP) of ≤15 mm Hg, given a normal left ventricular filling pressure (LVFP). However, recent studies have shown that, in PAH patients, diagnosis based on PCWP can erroneously classify a significant number of patients compared with diagnosis based on left ventricular end-diastolic pressure (LVEDP). Therefore, we sought to compare the diagnostic accuracy of end-expiratory PCWP and LVEDP measurements in patients suspected of having pulmonary hypertension (PH).
  
  
  METHODS
  We reviewed the hemodynamic data from 122 patients suspected of having PH who underwent simultaneous right- and left-side heart catheterizations at a PH referral center from 2006 to 2011.
  
  
  RESULTS
  PH was diagnosed in 105 patients, 79% of whom (n = 83) showed a pre-capillary pattern according to the LVEDP measurement. Ninety percent of patients with PCWP ≤15 mm Hg were correctly classified as having pre-capillary PH. However, 39% of patients with a PCWP >15 mm Hg had LVEDP ≤15 mm Hg and would have been erroneously diagnosed with pulmonary venous hypertension based on their PCWP measurements alone. The sensitivity and specificity was 0.89 and 0.64, respectively. A Bland-Altman analysis of the PCWP and LVEDP measurements revealed a mean bias of 0.3 mm Hg with 95% limits of agreement of -7.2 to 7.8 mm Hg.
  
  
  CONCLUSIONS
  A PCWP ≤15 mm Hg was found to be a reliable indicator of normal LVFP in pre-capillary PH patients. When measured properly and analyzed in the clinical context, PCWP is a valuable tool for accurate diagnosis of PAH.
authors.forename: Rudolf K F
authors.initials: RK
authors.lastname: Oliveira
authors.affiliation: Pulmonary Vascular Group, Division of Respiratory Medicine, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Rudolf K F
authors.initials: RK
authors.lastname: de Oliveira
authors.affiliation: Pulmonary Vascular Group, Division of Respiratory Medicine, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Eloara V M
authors.initials: EV
authors.lastname: Ferreira
authors.affiliation: Pulmonary Vascular Group, Division of Respiratory Medicine, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Roberta P
authors.initials: RP
authors.lastname: Ramos
authors.affiliation: Pulmonary Vascular Group, Division of Respiratory Medicine, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Carolina M S
authors.initials: CM
authors.lastname: Messina
authors.affiliation: Hemodynamic Unit, Division of Cardiology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Carlos E B
authors.initials: CE
authors.lastname: Kapins
authors.affiliation: Hemodynamic Unit, Division of Cardiology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Célia M C
authors.initials: CM
authors.lastname: Silva
authors.affiliation: Pulmonary Vascular Group, Division of Respiratory Medicine, Federal University of São Paulo, São Paulo, Brazil. Electronic address: jaqueota@gmail.com.
authors.forename: Jaquelina S
authors.initials: JS
authors.lastname: Ota-Arakaki
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: left ventricular end-diastolic pressure; left ventricular filling pressure; pulmonary arterial hypertension; pulmonary capillary wedge pressure; right heart catheterization