0
Original Research: PULMONARY VASCULAR DISEASE |

Right Ventricular Pressure Waveform and Wave Reflection Analysis in Patients With Pulmonary Arterial Hypertension*

Mustafa Karamanoglu, PhD; Michael McGoon, MD, FCCP; Robert P. Frantz, MD; Raymond L. Benza, MD; Robert C. Bourge, MD; Robyn J. Barst, MD, FCCP; Barbro Kjellström, BS; Tom D. Bennett, PhD
Author and Funding Information

*From NT&D Research, Medtronic Inc. (Drs. Karamanoglu and Bennett, and Ms. Kjellström), Minneapolis, MN; Division of Cardiovascular Diseases (Drs. McGoon and Frantz), Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN; Department of Medicine (Drs. Benza and Bourge), University of Alabama at Birmingham, Birmingham, AL; and Department of Pediatrics (Dr. Barst), Columbia University College of Physicians and Surgeons, New York, NY.

Correspondence to: Mustafa Karamanoglu, PhD, NT & D Research, Medtronic Inc, 7000 Central Ave NE, CW320, Fridley, MN 55432; e-mail: mustafa.karamanoglu@Medtronic.com



Chest. 2007;132(1):37-43. doi:10.1378/chest.06-2690
Text Size: A A A
Published online

Background: Cardiac index is an important determinant of outcome in patients with idiopathic pulmonary artery hypertension (IPAH). An implantable hemodynamic monitor (IHM) [Chronicle; Medtronic; Minneapolis, MN; a system limited to investigational use only] that records right ventricular (RV) pressure waveforms continuously may increase our understanding of IPAH and improve therapeutic selections and outcomes. The aim of this study was to investigate whether the RV pressure waveform utilizing an IHM can be used to estimate the magnitude of pressure wave reflection and cardiac index in patients with IPAH in acute settings.

Methods: In eight patients with pulmonary arterial hypertension, RV pressure waveforms were recorded utilizing the IHM, and breath-by-breath cardiac index was recorded during acute IV epoprostenol infusion at 3, 6 and 9 ng/kg/min. Late systolic pressure augmentation and cardiac index were estimated using the RV pressure waveforms and correlated with direct measurement of cardiac index.

Results: At baseline, the cardiac index was 2.1 ± 0.2 L/min/m2, total pulmonary resistance index was 38 ± 2 Wood U/m2, and RV systolic pressure was 92 ± 4 mm Hg. Wave reflection accounted for 29 ± 1 mm Hg of the RV systolic pressure. During epoprostenol infusion, total pulmonary resistance index and wave reflection decreased (− 15 ± 4 Wood U/m2, p < 0.001, and − 5 ± 2 mm Hg, p < 0.05, respectively). The breath-by-breath cardiac index correlated with the RV pressure waveform cardiac index estimates (r2 = 0.95).

Conclusions: RV pressure waveform analysis provides continuous hemodynamic assessments including cardiac index in acute settings. Once confirmed in long-term settings, this information may prove useful in optimizing a treatment regimen in patients with IPAH.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543