Pulmonary capillary wedge pressure augments right ventricular pulsatile loading

Ryan J. Tedford, Paul M. Hassoun, Stephen C. Mathai, Reda E. Girgis, Stuart D. Russell, David R. Thiemann, Oscar H. Cingolani, James O. Mudd, Barry A Borlaug, Margaret May Redfield, David J. Lederer, David A. Kass

Research output: Contribution to journalArticle

182 Citations (Scopus)

Abstract

Background - Right ventricular failure from increased pulmonary vascular loading is a major cause of morbidity and mortality, yet its modulation by disease remains poorly understood. We tested the hypotheses that, unlike the systemic circulation, pulmonary vascular resistance (R PA) and compliance (C PA) are consistently and inversely related regardless of age, pulmonary hypertension, or interstitial fibrosis and that this relation may be changed by elevated pulmonary capillary wedge pressure, augmenting right ventricular pulsatile load. Methods and Results - Several large clinical databases with right heart/pulmonary catheterization data were analyzed to determine the R PA-C PA relationship with pulmonary hypertension, pulmonary fibrosis, patient age, and varying pulmonary capillary wedge pressure. Patients with suspected or documented pulmonary hypertension (n=1009) and normal pulmonary capillary wedge pressure displayed a consistent R PA-C PA hyperbolic (inverse) dependence, C PA=0.564/(0.047+R PA), with a near-constant resistance-compliance product (0.48±0.17 seconds). In the same patients, the systemic resistance-compliance product was highly variable. Severe pulmonary fibrosis (n=89) did not change the R PA-C PA relation. Increasing patient age led to a very small but statistically significant change in the relation. However, elevation of the pulmonary capillary wedge pressure (n=8142) had a larger impact, significantly lowering C PA for any R PA and negatively correlating with the resistance-compliance product (P<0.0001). Conclusions - Pulmonary hypertension and pulmonary fibrosis do not significantly change the hyperbolic dependence between R PA and C PA, and patient age has only minimal effects. This fixed relationship helps explain the difficulty of reducing total right ventricular afterload by therapies that have a modest impact on mean R PA. Higher pulmonary capillary wedge pressure appears to enhance net right ventricular afterload by elevating pulsatile, relative to resistive, load and may contribute to right ventricular dysfunction.

Original languageEnglish (US)
Pages (from-to)289-297
Number of pages9
JournalCirculation
Volume125
Issue number2
DOIs
StatePublished - Jan 17 2012

Fingerprint

Pulmonary Wedge Pressure
Compliance
Pulmonary Hypertension
Pulmonary Fibrosis
Right Ventricular Dysfunction
Lung
Cardiac Catheterization
Patient Compliance
Vascular Resistance
Blood Vessels
Fibrosis
Databases
Morbidity
Mortality

Keywords

  • heart failure
  • heart ventricles
  • hemodynamics
  • hypertension, pulmonary
  • pulmonary circulation
  • pulmonary wedge pressure
  • vascular resistance

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Tedford, R. J., Hassoun, P. M., Mathai, S. C., Girgis, R. E., Russell, S. D., Thiemann, D. R., ... Kass, D. A. (2012). Pulmonary capillary wedge pressure augments right ventricular pulsatile loading. Circulation, 125(2), 289-297. https://doi.org/10.1161/CIRCULATIONAHA.111.051540

Pulmonary capillary wedge pressure augments right ventricular pulsatile loading. / Tedford, Ryan J.; Hassoun, Paul M.; Mathai, Stephen C.; Girgis, Reda E.; Russell, Stuart D.; Thiemann, David R.; Cingolani, Oscar H.; Mudd, James O.; Borlaug, Barry A; Redfield, Margaret May; Lederer, David J.; Kass, David A.

In: Circulation, Vol. 125, No. 2, 17.01.2012, p. 289-297.

Research output: Contribution to journalArticle

Tedford, RJ, Hassoun, PM, Mathai, SC, Girgis, RE, Russell, SD, Thiemann, DR, Cingolani, OH, Mudd, JO, Borlaug, BA, Redfield, MM, Lederer, DJ & Kass, DA 2012, 'Pulmonary capillary wedge pressure augments right ventricular pulsatile loading', Circulation, vol. 125, no. 2, pp. 289-297. https://doi.org/10.1161/CIRCULATIONAHA.111.051540
Tedford RJ, Hassoun PM, Mathai SC, Girgis RE, Russell SD, Thiemann DR et al. Pulmonary capillary wedge pressure augments right ventricular pulsatile loading. Circulation. 2012 Jan 17;125(2):289-297. https://doi.org/10.1161/CIRCULATIONAHA.111.051540
Tedford, Ryan J. ; Hassoun, Paul M. ; Mathai, Stephen C. ; Girgis, Reda E. ; Russell, Stuart D. ; Thiemann, David R. ; Cingolani, Oscar H. ; Mudd, James O. ; Borlaug, Barry A ; Redfield, Margaret May ; Lederer, David J. ; Kass, David A. / Pulmonary capillary wedge pressure augments right ventricular pulsatile loading. In: Circulation. 2012 ; Vol. 125, No. 2. pp. 289-297.
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abstract = "Background - Right ventricular failure from increased pulmonary vascular loading is a major cause of morbidity and mortality, yet its modulation by disease remains poorly understood. We tested the hypotheses that, unlike the systemic circulation, pulmonary vascular resistance (R PA) and compliance (C PA) are consistently and inversely related regardless of age, pulmonary hypertension, or interstitial fibrosis and that this relation may be changed by elevated pulmonary capillary wedge pressure, augmenting right ventricular pulsatile load. Methods and Results - Several large clinical databases with right heart/pulmonary catheterization data were analyzed to determine the R PA-C PA relationship with pulmonary hypertension, pulmonary fibrosis, patient age, and varying pulmonary capillary wedge pressure. Patients with suspected or documented pulmonary hypertension (n=1009) and normal pulmonary capillary wedge pressure displayed a consistent R PA-C PA hyperbolic (inverse) dependence, C PA=0.564/(0.047+R PA), with a near-constant resistance-compliance product (0.48±0.17 seconds). In the same patients, the systemic resistance-compliance product was highly variable. Severe pulmonary fibrosis (n=89) did not change the R PA-C PA relation. Increasing patient age led to a very small but statistically significant change in the relation. However, elevation of the pulmonary capillary wedge pressure (n=8142) had a larger impact, significantly lowering C PA for any R PA and negatively correlating with the resistance-compliance product (P<0.0001). Conclusions - Pulmonary hypertension and pulmonary fibrosis do not significantly change the hyperbolic dependence between R PA and C PA, and patient age has only minimal effects. This fixed relationship helps explain the difficulty of reducing total right ventricular afterload by therapies that have a modest impact on mean R PA. Higher pulmonary capillary wedge pressure appears to enhance net right ventricular afterload by elevating pulsatile, relative to resistive, load and may contribute to right ventricular dysfunction.",
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AU - Russell, Stuart D.

AU - Thiemann, David R.

AU - Cingolani, Oscar H.

AU - Mudd, James O.

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