SESSION TYPE: Pulmonary Hypertension II
PRESENTED ON: Monday, October 22, 2012 at 04:00 PM - 05:30 PM
PURPOSE: Right heart catheterization (RHC) represents the main method for diagnosing pulmonary hypertension (PH). It is usually prompted by abnormal 2D echo findings that infer the presence of elevated pulmonary pressure. A large percentage of these patients have left ventricular dysfunction with increased pulmonary capillary wedge pressure (PCWP) on the RHC suggestive of pulmonary venous hypertension. An accurate noninvasive method of assessing this might prevent unnecessary RHC's in this patient population. We hypothesize that the left atrium (LA) size measured non-invasively will correlate well with the PCWP in patients referred for RHC to evaluate for PAH. The LA size can be quantified either by estimating LA area using Computer Tomography (CT) measurements or by measuring LA systolic diameter on the echo-cardiogram.
METHODS: In order to demonstrate the correlation between LA area and PCWP we retrospectively reviewed the charts of all adult patients referred to our center for a RHC as part of the evaluation for PH from 2/2000 to 7/ 2010. LA area was measured in the mediastinal window of the CT of the Thorax at the point where LA appeared the largest; horizontal length (L) and vertical width (W) of the LA were measured; LA area was calculated (LA area = L × W) LA area was corrected for patient size by dividing the calculated area of the LA by the horizontal chest wall length (Lcw), corrected-LA area = [L × W]/Lcw and then compared and correlated with the PCWP obtained on the RHC. The LA systolic diameter on the echo-cardiogram was previously recorded and correlation with the PCWP measurement was obtained.
RESULTS: A total of 102 patients, who underwent evaluation for PH from 2001 to 2010 were included. LA area ranged from 12 to 63 cm2, the corrected-LA area ranged from 0.5 to 2.7 cm2 and the PCWP ranged from 4 to 30 mm Hg. The corrected-LA area correlated well with the PCWP with a Pearson's correlation co-efficient of 0.4809.
CONCLUSIONS: LA size represents a noninvasive method of predicting the PCWP in patients evaluated for pulmonary hypertension. This study confirms the results of our previous study that showed that the LA systolic diameter on the echo-cardiogram correlates with the PCWP with a Pearson's correlation co-efficient of 0.5337.
CLINICAL IMPLICATIONS: Based on our data it appears that both the echo-cardiogram measurement of the LA systolic diameter and CT based estimation of the LA area provide a reliable prediction of the PCWP
DISCLOSURE: The following authors have nothing to disclose: Irina Timofte, Nicholas Ladikos, Hassan Alnuaimat
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