Objectives: Right ventricular (RV) afterload is best described by a pulmonary arterial impedance (PVZ) spectrum, which integrates pulmonary vascular resistance (PVR), elastance, and wave reflection. We evaluated the feasibility of PVZ determinations in patients with pulmonary arterial hypertension (PAH) during routine right heart catheterization and Doppler echocardiography.
Design: Prospective study.
Setting: Academic hospital.
Patients: Twenty-two patients with PAH.
Interventions: Right heart catheterization with a fluid-filled Swan-Ganz catheter, Doppler echocardiography, and administration of inhaled nitric oxide (NO) [10 to 20 ppm; 17 patients], maximum tolerated dose of IV epoprostenol (average, 8.5 ng/kg/min; 5 patients), and IV dobutamine (8 μg/kg/min; 8 patients).
Measurements and results: PVZ was calculated from the spectral analysis of synchronized pulmonary artery pressure (Ppa) and flow waves. The mean (± SE) Ppa was 63 ± 3 mm Hg, and the mean PVR was 16 ± 2 Wood units. The PVZ spectrum was markedly shifted to higher than normal pressures and frequencies, with a mean 0-Hz impedance (Z0) of 1,506 ± 138 dyne · s · cm−5, and a mean characteristic impedance (Zc) of 124 ± 11 dyne · s · cm−5, which are in keeping with data from previous studies. Inhaled NO levels decreased Ppa, PVR, Z0, and Zc without a change in cardiac output. Epoprostenol administration did not affect Ppa, increased cardiac output, and decreased Z0 and Zc. Dobutamine administration increased cardiac output and Ppa, and decreased PVR and Z0, without changing Zc.
Conclusions: The determination of PVZ to quantify RV afterload is feasible during routine right heart catheterization and Doppler echocardiography. The measurement is sensitive to pharmacologic interventions.