Number of attempts and interventions to obtain a valid pulmonary artery wedge pressure.

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular diagnosis and therapy Pub Date : 2024-10-31 Epub Date: 2024-09-24 DOI:10.21037/cdt-24-189

Eduard Krishtopaytis, Mohammed Obeidat, Noor Ramahi, Fatima Abdeljaleel, James Lane, David Toth, Deborah Paul, Matthew T Siuba, Adriano R Tonelli

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Abstract

Background: A valid pulmonary artery wedge pressure (PAWP) is essential for the hemodynamic characterization of pulmonary hypertension (PH). We prospectively investigated the methodology for obtaining a valid PAWP measurement, while assessing the impact of prespecified factors on its determination.

Methods: In this prospective observational cohort study, we included consecutive patients who underwent right heart catheterization (RHC) using fluoroscopy at the Pulmonary Vascular Disease program at Cleveland Clinic, between February and May 2023. Once a valid PAWP was obtained, we recorded the number of attempts, reason for repeating the determination, pulmonary artery location, depth of the pulmonary artery catheter (PAC) from the introducer hub, and inflation volume of the PAC balloon.

Results: We included 195 patients, age: 57.5±15.7 years, 111 (57%) women, 156 (80%) with PH. The PAWP was 16.4±5.9 mmHg, requiring 1, 2 and ≥3 attempts for a valid measurement in 139 (71%), 39 (20%) and 17 (9%) patients, respectively. PAWP was repeated due to abnormal waveform, incomplete wedge and over wedge. A valid PAWP was obtained in the right pulmonary circulation in 168 (86%) patients, and in the lower third in 134 (69%), middle third in 58 (30%), and upper third of the lung in 3 (2%) patients. The pulmonary artery catheter balloon inflation at valid PAWP was 1.0±0.3 mL, at a distance from the introducer hub of 52.6±5.2 cm. Aspiration of blood in PAW position was obtained in 141 (72%) patients with an arterial oxygenation of 97% (95-99%). The number of measurements for a valid PAWP was directly associated with mean pulmonary artery pressure (mPAP) (r=0.18, P=0.01), PAWP (r=0.22, P=0.002), and pulmonary artery diameter on computed tomography (r=0.16, P=0.04).

Conclusions: A valid PAWP was obtained during the first or second attempt in about 90% of patients that undergo RHC. Advanced interventions such as relocating the PAC to a different place of the same lung or contralateral pulmonary circulation are needed in about 10% of patients.

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获得有效肺动脉楔压的尝试和干预次数。

背景：有效的肺动脉楔压（PAWP）对于肺动脉高压（PH）的血液动力学特征描述至关重要。我们对获得有效肺动脉楔压测量的方法进行了前瞻性研究，同时评估了预设因素对其测定的影响：在这项前瞻性观察性队列研究中，我们纳入了 2023 年 2 月至 5 月期间在克利夫兰诊所肺血管疾病项目中使用透视技术接受右心导管检查（RHC）的连续患者。一旦获得有效的 PAWP，我们将记录尝试的次数、重复测定的原因、肺动脉位置、肺动脉导管 (PAC) 距导引器枢纽的深度以及 PAC 球囊的充气量：共纳入 195 例患者，年龄（57.5±15.7）岁，女性 111 例（57%），PH 患者 156 例（80%）。PAWP为16.4±5.9 mmHg，分别有139名（71%）、39名（20%）和17名（9%）患者需要尝试1次、2次和≥3次才能进行有效测量。由于波形异常、楔形不完整和楔形过大，需要重复测量 PAWP。168（86%）名患者的右肺循环获得了有效的 PAWP，134（69%）名患者的肺下三分之一处、58（30%）名患者的肺中三分之一处和 3（2%）名患者的肺上三分之一处获得了有效的 PAWP。在有效 PAWP 时，肺动脉导管球囊充气量为 1.0±0.3 mL，与导管毂的距离为 52.6±5.2 cm。141（72%）名患者在 PAW 位置吸血，动脉氧合率为 97%（95-99%）。有效 PAWP 的测量次数与平均肺动脉压（mPAP）（r=0.18，P=0.01）、PAWP（r=0.22，P=0.002）和计算机断层扫描肺动脉直径（r=0.16，P=0.04）直接相关：约 90% 的接受 RHC 的患者在第一次或第二次尝试时都能获得有效的 PAWP。约有 10% 的患者需要进行高级干预，如将 PAC 移至同一肺部的不同位置或对侧肺循环。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiovascular diagnosis and therapy Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

4.20%

发文量

期刊介绍： The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.