Ennala Sravanthi, Melillo Celia A, Lane James E, Tonelli Adriano R
Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
Inflammation and Immunity Department, Cleveland Clinic, Cleveland, OH, USA.
Cardiovasc Diagn Ther. 2022 Feb;12(1):37-41. doi: 10.21037/cdt-21-515.
Right heart catheterization (RHC), including a pulmonary artery wedge pressure (PAWP) determination, is necessary to categorize the hemodynamic type of pulmonary hypertension (PH). The potential hemodynamic implications of a pulmonary artery catheter (PAC) balloon inflation in PH have not been formally tested.
We assessed the hemodynamic impact of the PAC balloon inflation during RHC by measuring systolic, diastolic, and mean pulmonary artery pressure (mPAP) in all patients, and cardiac output (CO) by thermodilution in a subgroup of patients. Hemodynamic measurements were obtained both with PAC balloon deflated and fully inflated (1.5 mL of air), while the PAC was free floating in the pulmonary artery before wedging. We calculated total pulmonary resistance (TPR).
We included 210 patients, age 58±14 years, 134 (64%) women. Patients had no PH (n: 12, 6%), PH group 1 (n: 68, 33%), 2 (n: 86, 41%), 3 (n: 11, 5%), 4 (n: 29, 14%), and 5 (n: 3, 1%). The mean ± standard deviation (SD) at end-expiration mPAP (balloon-up minus down) (n: 209) was -0.02±1.59 mmHg (range, -5.0 to 4.0 mmHg; P=0.84), while the TPR (n: 62) was -0.27±1.2 Wood units (WU) (range, -4.8 to 2.2 WU; P=0.08); without significant variation based on the type of PH group or degree of pulmonary vascular resistance (PVR). Interestingly, the change in mPAP at end-expiration with PAC balloon inflation was higher in women (mean ± SD: 0.31±1.43 mmHg) than men (mean ± SD: -0.61±1.70 mmHg) (P<0.001).
Balloon inflation of the PAC in the main pulmonary artery had no significant impact on the mPAP or TPR, even when only including patients with group 1 PH or selecting a subgroup with a higher PVR.
右心导管检查（RHC），包括测定肺动脉楔压（PAWP），对于对肺动脉高压（PH）的血流动力学类型进行分类是必要的。肺动脉导管（PAC）球囊充气在PH中的潜在血流动力学影响尚未经过正式测试。
我们通过测量所有患者的收缩压、舒张压和平均肺动脉压（mPAP），并在一组亚组患者中通过热稀释法测量心输出量（CO），评估了RHC期间PAC球囊充气的血流动力学影响。在楔入前，当PAC在肺动脉中自由漂浮时，在PAC球囊放气和完全充气（1.5 mL空气）的情况下均进行血流动力学测量。我们计算了总肺阻力（TPR）。
我们纳入了210例患者，年龄58±14岁，134例（64%）为女性。患者无PH（n：12，6%），PH 1组（n：68，33%），2组（n：86，41%），3组（n：11，5%），4组（n：29，14%）和5组（n：3，1%）。呼气末mPAP（球囊充气后减去充气前）的平均值±标准差（SD）（n：209）为-0.02±1.59 mmHg（范围，-5.0至4.0 mmHg；P = 0.84），而TPR（n：62）为-0.27±1.2伍德单位（WU）（范围，-4.8至2.2 WU；P = 0.08）；根据PH组类型或肺血管阻力（PVR）程度无显著差异。有趣的是，PAC球囊充气时呼气末mPAP的变化在女性中（平均值±SD：0.31±1.43 mmHg）高于男性（平均值±SD：-0.61±1.70 mmHg）（P<0.001）。
即使仅纳入1组PH患者或选择PVR较高的亚组，主肺动脉中PAC的球囊充气对mPAP或TPR也没有显著影响。
