Pulmonary hypertension diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Richard Channick, M.D.; Assistant Editor(s)-in-Chief: Ralph Matar, Lisa Prior, Ann Slater, R.N.; José Eduardo Riceto Loyola Junior, M.D.[2]
Overview
Pulmonary hypertension is defined by a mean pulmonary arterial pressure higher than 25mmHg. It can be assessed by echocardiography, the diagnostic study of choice due to its low risk and useful information that it can provide, and right heart cardiac catheterization to confirm the diagnosis.
Diagnosis
- The diagnostic approach to PH aims to:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]
- Confirm the diagnosis of PH
- Determine the classification group of PH
- Specify the possible etiology for PH, if present
- Evaluate the hemodynamic status of the patient
Diagnostic Study of Choice
- Echocardiography is the diagnostic study of choice, as it can:
- Estimate the pulmonary artery systolic pressure (PSAP);
- Evaluate for possible causes of pulmonary hypertension;
- Assess the presence of right atrial or ventricular enlargement, hypertrophy, or decreased right ventricular function;
- May also evaluate left heart chambers, especially if they are causing pulmonary hypertension;
- Although pulmonary arterial pressure can be estimated on the basis of echocardiography, pressure sampling with a Swan-Ganz catheter provides the most definite measurement. PAOP and PVR cannot be measured directly with echocardiography.
- Therefore the diagnosis of PAH requires a cardiac catheterization. A Swan-Ganz catheter can also measure the cardiac output, which is far more important in measuring disease severity than the pulmonary arterial pressure.
- Normal pulmonary arterial pressure in a person living at sea level has a mean value between 12 and 16 mm Hg. Definite pulmonary hypertension is present when mean pressures at rest exceed 25 mm Hg. If mean pulmonary artery pressure rises above 30 mm Hg (4000 Pa) with exercise, that is also considered pulmonary hypertension.
Diagnostic criteria
A diagnosis of PAH requires the presence of pulmonary hypertension with two other conditions.
- Pulmonary artery occlusion pressure (PAOP or PCWP) must be less than 15 mm Hg (2000 Pa)
- Pulmonary vascular resistance (PVR) must be greater than 3 Wood units (240 dyn•s•cm-5 or 2.4 mN•s•cm-5).
References
- ↑ Shitrit, D.; Bendayan, D.; Rudensky, B.; Izbicki, G.; Huerta, M.; Fink, G.; Kramer, MR. (2002). "Elevation of ELISA d-dimer levels in patients with primary pulmonary hypertension". Respiration. 69 (4): 327–9. doi:63270 Check
|doi=value (help). PMID 12169745. - ↑ Shitrit, D.; Bendayan, D.; Bar-Gil-Shitrit, A.; Huerta, M.; Rudensky, B.; Fink, G.; Kramer, MR. (2002). "Significance of a plasma D-dimer test in patients with primary pulmonary hypertension". Chest. 122 (5): 1674–8. PMID 12426270. Unknown parameter
|month=ignored (help) - ↑ Rich S, Dantzker DR, Ayres SM, Bergofsky EH, Brundage BH, Detre KM; et al. (1987). "Primary pulmonary hypertension. A national prospective study". Ann Intern Med. 107 (2): 216–23. PMID 3605900.
- ↑ Budev MM, Arroliga AC, Jennings CA (2003). "Diagnosis and evaluation of pulmonary hypertension". Cleve Clin J Med. 70 Suppl 1: S9–17. PMID 12716138. Unknown parameter
|month=ignored (help) - ↑ Carolyn H. Welsh; Michael E. Hanley (2003). Current diagnosis & treatment in pulmonary medicine. New York: Lange Medical Books / McGraw-Hill. ISBN 0-07-121971-4.
- ↑ Wiedemann, R.; Ghofrani, HA.; Weissmann, N.; Schermuly, R.; Quanz, K.; Grimminger, F.; Seeger, W.; Olschewski, H. (2001). "Atrial natriuretic peptide in severe primary and nonprimary pulmonary hypertension: response to iloprost inhalation". J Am Coll Cardiol. 38 (4): 1130–6. PMID 11583893. Unknown parameter
|month=ignored (help) - ↑ Bossone E, Paciocco G, Iarussi D; et al. (2002). "The prognostic role of the ECG in primary pulmonary hypertension". Chest. 121 (2): 513–8. PMID 11834666. Unknown parameter
|month=ignored (help) - ↑ Kawut SM, Silvestry FE, Ferrari VA; et al. (1999). "Extrinsic compression of the left main coronary artery by the pulmonary artery in patients with long-standing pulmonary hypertension". Am. J. Cardiol. 83 (6): 984–6, A10. PMID 10190427. Unknown parameter
|month=ignored (help) - ↑ Simon O'Connor MBBS FRACP DDU; Nicholas P. Hirsch MBBS FRCA FRCP (2009). Clinical Examination: A Systematic Guide to Physical Diagnosis. Edinburgh: Churchill Livingstone. ISBN 0-7295-3905-9.
- ↑ Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA; et al. (2009). "Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT)". Eur Heart J. 30 (20): 2493–537. doi:10.1093/eurheartj/ehp297. PMID 19713419.
- ↑ Thompson, Paul Richard; Topol, Eric J.; Califf, Robert M.; Prystowsky, Eric N.; Thomas, James Alan (2007). Textbook of cardiovascular medicine. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7012-2.
- ↑ Nagaya, N.; Nishikimi, T.; Uematsu, M.; Satoh, T.; Kyotani, S.; Sakamaki, F.; Kakishita, M.; Fukushima, K.; Okano, Y. (2000). "Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension". Circulation. 102 (8): 865–70. PMID 10952954. Unknown parameter
|month=ignored (help) - ↑ Kucher, N.; Printzen, G.; Goldhaber, SZ. (2003). "Prognostic role of brain natriuretic peptide in acute pulmonary embolism". Circulation. 107 (20): 2545–7. doi:10.1161/01.CIR.0000074039.45523.BE. PMID 12742987. Unknown parameter
|month=ignored (help) - ↑ ten Wolde, M.; Tulevski, II.; Mulder, JW.; Söhne, M.; Boomsma, F.; Mulder, BJ.; Büller, HR. (2003). "Brain natriuretic peptide as a predictor of adverse outcome in patients with pulmonary embolism". Circulation. 107 (16): 2082–4. doi:10.1161/01.CIR.0000070020.79932.DB. PMID 12707233. Unknown parameter
|month=ignored (help) - ↑ Leuchte, HH.; Baumgartner, RA.; Nounou, ME.; Vogeser, M.; Neurohr, C.; Trautnitz, M.; Behr, J. (2006). "Brain natriuretic peptide is a prognostic parameter in chronic lung disease". Am J Respir Crit Care Med. 173 (7): 744–50. doi:10.1164/rccm.200510-1545OC. PMID 16415273. Unknown parameter
|month=ignored (help)