Misclassification of Pulmonary Hypertension Due to Reliance on Pulmonary Capillary Wedge Pressure Rather Than Left Ventricular End-Diastolic Pressure
Misclassification of Pulmonary Hypertension Due to Reliance on Pulmonary Capillary Wedge Pressure Rather Than Left Ventricular End-Diastolic Pressure
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DOI：
10.1378/chest.08-2784
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发表时间：
2009-07-01
期刊：
影响因子：
9.6
通讯作者：
Taichman, Darren B.
中科院分区：
文献类型：
--
作者：
Halpern, Scott D.;Taichman, Darren B.
Background: Pulmonary arterial hypertension (PAH) is typically distinguished from pulmonary venous hypertension (PVH) by documenting a pulmonary capillary wedge pressure (PCWP) = 25 mm Hg], hemodynamic data were complete for 3,926 patients (90.9%). Of these, 580 patients (14.8%) met the criteria for PAH with a PCWP 15 min Hg. Such discrepancies remained common among patients with a pulmonary vascular resistance > 3 Wood units and those being catheterized specifically to evaluate PH. PCWP provided moderate discrimination between patients with high vs normal LVEDP (area under the receiver operating characteristic curve, 0.84; 95% confidence interval, 0.81 to 0.86) but was poorly calibrated to LVEDP (Bland-Altman limits of agreement, - 15.2 to 9.5 mm Hg; Hosmer-Lemeshow goodness-of-fit xi(2) statistic, 155.4; p < 0.0001).Conclusions: Roughly half of the patients presumed to have PAH based on PCWP may be found to have PVH based on LVEDP. Reliance on PCWP may result in the dangerous or cost-ineffective use of pulmonary vasodilators for patients with left-heart disease. Furthermore, without assessing LVEDP, investigators may include patients with left-heart disease in therapeutic trials of PAH drugs, thereby limiting their ability to detect beneficial drug effects. (CHEST 2009; 136:37-43)
