0
Correspondence |

Systolic BP and Heart Rate in Pulmonary HypertensionSystolic BP, Heart Rate in Pulmonary Hypertension FREE TO VIEW

Carla Nobre, MD; Boban Thomas, MD, FCCP
Author and Funding Information

From the Centro Hospitalar Barreiro Montijo – Internal Medicine (Dr Nobre); and Centro Hospitalar Barreiro Montijo – Cardiology (Dr Thomas).

Correspondence to: Boban Thomas, MD, FCCP, Centro Hospitalar Barreiro Montijo – Cardiology, Barreiro, Barreiro 1900-280, Portugal; e-mail: bobantho@gmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(2):414. doi:10.1378/chest.13-2119
Text Size: A A A
Published online
To the Editor:

In a recent issue of CHEST (September 2013), Bersohn et al1 used the ratio of systolic BP to heart rate (HR) to identify a cohort of patients at high risk in the Registry to Evaluate Early and Long-term PAH [Pulmonary Arterial Hypertension] Disease Management (REVEAL Registry). The work ought to be commended for the identification of two simple bedside clinical parameters to provide prognostic information, which is extremely valuable for clinicians like us. However, we wish to note that it is similar to the shock index (SI), which is the ratio of HR to systolic BP, a variable that provides prognostic information about patients with acute pulmonary embolism (APE). As the authors have the raw data, it should be possible to know if the SI can be calculated in this cohort and if the information is as robust as the index they propose. If it is, we could have a common index that has prognostic value in both acute and chronic pulmonary hypertension. As some cases of APE evolve into chronic thromboembolic pulmonary hypertension, this index may have value in sequential follow-up.2

Our unpublished data have revealed that of 35 patients who presented to our district hospital with APE diagnosed by multidetector CT pulmonary angiography, 15 underwent thrombolytic therapy (12 received alteplase and three received tenecteplase). The prethrombolysis SI in the patients submitted to thrombolysis was higher (0.94 ± 0.23) compared with those who were treated with standard anticoagulation using heparin (0.70 ± 0.20). After thrombolysis, the SI calculated using the highest recorded BP and simultaneous HR in the first 24 h decreased to 0.63 ± 0.11 (P < .0001, paired t test). The systolic BP values were not different before and after thrombolysis in the group (125 ± 19 mm Hg vs 126 ± 13 mm Hg, respectively), but HR was significantly decreased postthrombolysis (106 ± 18 beats/min vs 80 ± 15 beats/min, P < .0001). Irrespective of the index used, the two parameters provide indirect information on cardiac output, with tachycardia being a unifying feature of low-output states.

References

Bersohn MM, Turner MP, Traiger GL, Frost AE, Shapiro S. Systemic BP and heart rate as prognostic indicators in pulmonary arterial hypertension. Chest. 2013;144(3):959-965. [CrossRef] [PubMed]
 
Kucher N, Luder CM, Dörnhöfer T, Windecker S, Meier B, Hess OM. Novel management strategy for patients with suspected pulmonary embolism. Eur Heart J. 2003;24(4):366-376. [CrossRef] [PubMed]
 

Figures

Tables

References

Bersohn MM, Turner MP, Traiger GL, Frost AE, Shapiro S. Systemic BP and heart rate as prognostic indicators in pulmonary arterial hypertension. Chest. 2013;144(3):959-965. [CrossRef] [PubMed]
 
Kucher N, Luder CM, Dörnhöfer T, Windecker S, Meier B, Hess OM. Novel management strategy for patients with suspected pulmonary embolism. Eur Heart J. 2003;24(4):366-376. [CrossRef] [PubMed]
 
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.

Related Content

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

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