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Original Research: Pulmonary Vascular Disease |

Clinical Relevance of Fluid Challenge in Patients Evaluated for Pulmonary Hypertension

Michele D'Alto, MD, PhD; Emanuele Romeo, MD, PhD; Paola Argiento, MD, PhD; Yoshiki Motoji, MD, PhD; Anna Correra, MD; Giovanni Maria Di Marco, MD; Agostino Mattera Iacono, MD; Rosaria Barracano, MD; Antonello D'Andrea, MD, PhD; Gaetano Rea, MD; Berardo Sarubbi, MD, PhD; Maria Giovanna Russo, MD; Robert Naeije, MD, PhD
Author and Funding Information

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

aDepartment of Cardiology, Second University of Naples, Naples, Italy

bDepartment of Pathophysiology, Free University of Brussels, Brussels, Belgium

cDepartment of Radiology, Monaldi Hospital, Naples, Italy

CORRESPONDENCE TO: Michele D’Alto, MD, PhD, Department of Cardiology, Second University of Naples, Piazzale Ettore Ruggieri, 1, Naples 80128, Italy


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(1):119-126. doi:10.1016/j.chest.2016.08.1439
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Background  Fluid challenge may help in the differential diagnosis between pre- and postcapillary pulmonary hypertension (PH). However, the test is still in need of standardization and better defined clinical relevance.

Methods  Two hundred twelve patients referred for PH underwent a right-sided heart catheterization with measurements before and after rapid infusion of 7 mL/kg of saline. PH was defined as mean pulmonary artery pressure ≥ 25 mm Hg, and postcapillary PH was defined as pulmonary artery wedge pressure (PAWP) > 15 mm Hg. An increase in PAWP ≥ 18 mm Hg was considered diagnostic for postcapillary PH. At baseline, 66 patients received a diagnosis of no PH; 22, of postcapillary PH; and 124, of precapillary PH (mostly pulmonary arterial hypertension).

Results  After fluid challenge, five of 66 patients with no PH (8%) and eight of 124 with precapillary PH (6%) had the diagnosis reclassified as postcapillary PH. Fluid challenge was associated with an increase in PAWP by 7 ± 2 mm Hg in postcapillary PH and 3 ± 1 mm Hg in both precapillary PH and no-PH groups. Between-group differences were significant, but there was overlap. There were no adverse events related to fluid challenge. Prediction bands calculated from quadratic fits of the PAWP responses in pooled control subjects with no PH and patients with precapillary PH helped confirm 18 mm Hg as the cutoff for diagnosing postcapillary PH.

Conclusions  Fluid challenge with 7 mL/kg saline increases PAWP, more in postcapillary than in precapillary PH or in control subjects with no PH. A cutoff value of 18 mm Hg allows reclassification of 6% to 8% of patients with precapillary PH or normal hemodynamic characteristics at baseline.

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