Pulmonary Vascular Disease Program, University of Florida, Gainesville, FL, USA.
Chest. 2011 Jan;139(1):115-21. doi: 10.1378/chest.10-0981. Epub 2010 Jul 1.
Pulmonary artery occlusion pressure (PAOP) is used to differentiate patients with pulmonary hypertension (PH) associated with left-sided heart disease from other etiologies. Technical errors in the measurement of PAOP are common and lead to incorrect classification of the etiology of PH. We investigated the agreement among PAOP measurements obtained from both pulmonary arteries with balloon full (1.5 mL) and half (0.75 mL) inflation in patients undergoing right-sided heart catheterization for suspected PH.
Thirty-seven patients suspected or known to have PH who underwent right-sided heart catheterization were included. Seventy-six percent had PH (mean pulmonary arterial pressure > 25 mm Hg). The validity of the measurements was assessed by using five preestablished criteria based on hemodynamic, fluoroscopic, and gasometric data. For each patient, the measurement that most likely represented the left atrial pressure was labeled "best PAOP."
Seventy percent of all the PAOP measurements met at least four of the five preestablished criteria for validity. In patients with PH (n = 28), the mean ± SE PAOP was 23.1 ± 2 and 19.1 ± 2 mm Hg for balloon full and half inflation, respectively, in the right pulmonary artery and 23.54 ± 2 and 19.07 ± 2 mm Hg for balloon full and half inflation, respectively, in the left pulmonary artery (P = .05). Bland-Altman analysis revealed lower bias and narrower limits of agreement with balloon half inflation. Wedge angiography showed that some balloon inflations failed to occlude upstream flow, whereas others had collateral vessels draining after the occlusion.
PAOP can be falsely elevated in patients with PH according to the balloon inflation volume. Balloon half inflation was safe and correlated with higher precision and lower bias in the PAOP measurements.
肺动脉闭塞压（PAOP）用于区分与左侧心脏疾病相关的肺动脉高压（PH）患者与其他病因。PAOP 的测量技术错误很常见，导致 PH 病因的分类错误。我们研究了在疑似 PH 行右侧心导管检查的患者中，使用球囊完全（1.5 毫升）和半充盈（0.75 毫升）测量肺动脉 PAOP 之间的一致性。
共纳入 37 例疑似或已知患有 PH 并行右侧心导管检查的患者。76%的患者存在 PH（平均肺动脉压>25mmHg）。使用基于血流动力学、荧光透视和气体测量数据的五个预先设定的标准评估测量的有效性。对于每个患者，最可能代表左心房压力的测量被标记为“最佳 PAOP”。
所有 PAOP 测量中有 70%符合至少四个预先设定的有效性标准。在 PH 患者（n=28）中，右肺动脉球囊完全和半充盈时的平均肺动脉压分别为 23.1±2mmHg 和 19.1±2mmHg，左肺动脉分别为 23.54±2mmHg 和 19.07±2mmHg（P=0.05）。Bland-Altman 分析显示，球囊半充盈时的偏倚较小，一致性界限较窄。楔入造影显示，一些球囊充气未能完全阻塞上游血流，而其他球囊充气后存在侧支血管引流。
根据球囊充气量，PH 患者的 PAOP 可能会被错误地升高。球囊半充盈是安全的，与 PAOP 测量的更高精度和更低偏倚相关。
