LeVarge Barbara L, Pomerantsev Eugene, Channick Richard N
Dept of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
Dept of Cardiology, Massachusetts General Hospital, Boston, MA, USA.
Eur Respir J. 2014 Aug;44(2):425-34. doi: 10.1183/09031936.00209313. Epub 2014 Jun 12.
Current guidelines recommend measurement of pulmonary artery wedge pressure (PAWP) at end-expiration. However, this recommendation is not universally followed and may not be physiologically appropriate. We investigated the performance of end-expiratory PAWP in the evaluation of precapillary pulmonary hypertension patients. 329 spontaneously breathing patients undergoing right heart catheterisation were retrospectively classified as having a precapillary, post-capillary or mixed phenotype based on standardised clinical criteria. Tracings were reviewed to compare end-expiratory PAWP with PAWP averaged throughout the respiratory cycle; these values were correlated with the clinical classifications. Predictors of large respirophasic variation in PAWP were determined. Elevated end-expiratory PAWP (>15 mmHg) occurred in 29% of subjects with precapillary phenotype. There were no differences in demographics or clinical history between those with elevated and normal end-expiratory PAWP. Those with elevated end-expiratory PAWP had greater right atrial pressure and respirophasic PAWP variation. Among all subjects, the magnitude of respirophasic variation in PAWP was positively correlated with body mass index and respirophasic variation in left ventricular end-diastolic pressure. A significant proportion of precapillary pulmonary hypertension patients have end-expiratory PAWP >15 mmHg. Spontaneous positive end-expiratory intrathoracic pressure may contribute; in those cases, PAWP averaged throughout respiration may be a more accurate measurement.
当前指南建议在呼气末测量肺动脉楔压（PAWP）。然而，这一建议并未得到普遍遵循，而且在生理上可能并不合适。我们研究了呼气末PAWP在评估毛细血管前性肺动脉高压患者中的表现。根据标准化临床标准，对329例接受右心导管检查的自主呼吸患者进行回顾性分类，分为毛细血管前性、毛细血管后性或混合型表型。对描记图进行回顾，以比较呼气末PAWP与整个呼吸周期的平均PAWP；这些值与临床分类相关。确定了PAWP呼吸相变化较大的预测因素。29%的毛细血管前性表型受试者呼气末PAWP升高（>15 mmHg）。呼气末PAWP升高和正常的受试者在人口统计学或临床病史方面没有差异。呼气末PAWP升高的受试者右心房压力和呼吸相PAWP变化更大。在所有受试者中，PAWP呼吸相变化的幅度与体重指数和左心室舒张末期压力的呼吸相变化呈正相关。相当一部分毛细血管前性肺动脉高压患者呼气末PAWP>15 mmHg。自发性呼气末胸内正压可能起作用；在这些情况下，整个呼吸过程中的平均PAWP可能是更准确的测量值。
