title: A critical appraisal of transpulmonary and diastolic pressure gradients.
abstract: Pulmonary hypertension (PH) resulting from left heart failure is an increasingly recognized clinical entity. To distinguish isolated postcapillary PH from combined post- and precapillary PH, the use of a diastolic pressure gradient (DPG = diastolic Pulmonary Artery Pressure - Pulmonary Arterial Wedge Pressure, dPAP - PAWP) has been advocated over the transpulmonary pressure gradient (TPG = mean Pulmonary Artery Pressure - PAWP, mPAP - PAWP) since DPG was suggested to be independent of cardiac output (CO) and only slightly related to PAWP, while TPG depends on both. We quantitatively derived and compared the DPG and TPG Using right heart catheterization data (n = 1054), we determined systolic pulmonary artery pressure (sPAP), dPAP and mPAP, PAWP, and CO From this data, we derived TPG and DPG and tested their dependence on PAWP and CO We found that dPAP and sPAP are proportional with mPAP over a wide range of PAWP (1-31 mmHg), with dPAP = 0.62mPAP and sPAP = 1.61mPAP As a consequence, TPG and DPG are equally dependent on PAWP: TPG = mPAP - PAWP, and DPG = 0.62mPAP - PAWP Furthermore, we showed that both TPG and DPG depend on CO The absolute increase in DPG with CO is 62% of the TPG increase with CO, but the relative dependence is the same. Both TPG and DPG depend on PAWP and CO Thus, in principle, there are no major advantages for using DPG to distinguish postcapillary pulmonary hypertension from combined post- and precapillary pulmonary hypertension.
authors: Department of Cardiology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands ml.handoko@vumc.nl.
authors: M Louis
authors: ML
authors: Handoko
authors: Department of Pulmonary Diseases, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands Department of Physiology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands.
authors: Frances S
authors: FS
authors: De Man
authors: Department of Pulmonary Diseases, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands.
authors: Frank P T
authors: FP
authors: Oosterveer
authors: Department of Pulmonary Diseases, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands.
authors: Harm-Jan
authors: HJ
authors: Bogaard
authors: Department of Pulmonary Diseases, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands.
authors: Anton
authors: A
authors: Vonk-Noordegraaf
authors: Department of Pulmonary Diseases, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands Department of Physiology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands.
authors: Nico
authors: N
authors: Westerhof
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D006328:Cardiac Catheterization / Q000379:methods; D002302:Cardiac Output / Q000502:physiology*; D003971:Diastole / Q000502:physiology*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000503:physiopathology*; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012189:Retrospective Studies; D014655:Vascular Resistance / Q000502:physiology; D055815:Young Adult
keywords: Cardiac output; heart failure; physiology; pulmonary hypertension; pulmonary wedge pressure