Ohlsson A, Bennett T, Nordlander R, Rydén J, Aström H, Rydén L
Department of Cardiology, Karolinska Hospital, Stockholm, Sweden.
J Card Fail. 1995 Mar;1(2):161-8. doi: 10.1016/1071-9164(95)90018-7.
Pulmonary arterial diastolic pressure is an important parameter for hemodynamic monitoring in congestive heart failure. It is traditionally obtained through a pulmonary arterial catheter. If it could be obtained from a sensor in the right ventricle, chronic monitoring would be possible without the use of a pulmonary arterial catheter. This study is based on the hypothesis that pulmonary valve opening and pulmonary arterial diastolic pressure occur at the time of maximum positive rate of pressure development (dP/dt) in the right ventricle, when the pressures should be equal. Thus, right ventricular pressure at the time of maximum dP/dt (PAD index) should be a reasonable estimate of pulmonary arterial diastolic pressure. Eight patients with heart failure were catheterized and exposed to hemodynamic stress. Right ventricular and pulmonary arterial pressures were simultaneously recorded from a Millar (Houston, TX) catheter with two pressure transducers. The distal transducer was positioned in the bifurcation of the pulmonary artery and the proximal transducer was placed in the right ventricle. Pulmonary arterial diastolic pressure and PAD index were stored beat by beat on a bed-side computer. Acceptable recordings were obtained in all patients. Recordings from the individual patients showed a good covariation between PAD index and pulmonary arterial pressure during different hemodynamic manuevers, except during infusion of dobutamine, when the correlation was not as good. Pulmonary arterial diastolic pressure may be estimated from a transducer in the right ventricle, thus eliminating the need for a permanent pulmonary arterial catheter in an implantable hemodynamic monitoring system. Further studies are needed to verify the correlation on a long-term basis.
肺动脉舒张压是充血性心力衰竭血流动力学监测的一个重要参数。传统上它是通过肺动脉导管获得的。如果能从右心室的传感器获取该参数，那么无需使用肺动脉导管就能进行长期监测。本研究基于这样的假设：在右心室压力上升最大正速率（dP/dt）时会出现肺动脉瓣开放和肺动脉舒张压，此时两者压力应相等。因此，最大dP/dt时的右心室压力（肺动脉舒张压指数）应该是肺动脉舒张压的合理估计值。对8例心力衰竭患者进行了导管插入术并使其承受血流动力学应激。使用带有两个压力传感器的Millar（得克萨斯州休斯顿）导管同时记录右心室和肺动脉压力。远端传感器置于肺动脉分叉处，近端传感器置于右心室。肺动脉舒张压和肺动脉舒张压指数逐搏存储在床边计算机上。所有患者均获得了可接受的记录。各患者的记录显示，在不同血流动力学操作过程中，肺动脉舒张压指数与肺动脉压力之间存在良好的协变关系，但在输注多巴酚丁胺期间，相关性不佳。肺动脉舒张压可通过右心室中的传感器进行估计，从而在植入式血流动力学监测系统中无需使用永久性肺动脉导管。需要进一步研究以长期验证这种相关性。
