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Original Research |

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

Support: The authors have had no support to declare related to the manuscript.

Conflict of Interest: The authors have no conflict of interest to declare related to the manuscript.

Department of Cardiology, Second University of Naples, Naples, Italy

Department of Pathophysiology, Free University of Brussels, Brussels, Belgium

Department of Radiology, Monaldi Hospital, Naples, Italy

Address for Correspondence: Dr Michele D’Alto, Department of Cardiology, Second University of Naples, Naples, Italy.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.08.1439
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Published online

Abstract

Background  A fluid challenge may help to the differential diagnosis between pre- and post-capillary pulmonary hypertension (PH). However the test is still in need of standardization and better defined clinical relevance.

Methods and Results  Two-hundred-twelve patients referred for PH underwent a right heart catheterization with measurements before and after rapid infusion of 7 ml/kg of saline. PH was defined by a mean pulmonary artery pressure (mPAP) ≥ 25 mmHg and post-capillary PH by a wedged PAP (PAWP) > 15 mmHg. An increase in PAWP ≥ 18 mmHg was considered diagnostic for post-capillary PH. At baseline, 66 patients were diagnosed with no PH, 22 with post-capillary PH and 124 with pre-capillary PH (mostly pulmonary arterial hypertension, PAH). After fluid challenge 5/66 patients with no PH (8%) and 8/124 with pre-capillary PH (6%) were reclassified as post-capillary PH. Fluid challenge was associated with an increase in PAWP by 7±2 mmHg in post-capillary PH, and 3±1 mmHg in both pre-capillary PH and no-PH patients. 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 no-PH control and pre-capillary PH patients confirmed 18 mmHg as cut-off for the diagnosis of post-capillary PH.

Conclusions  Fluid challenge with 7 ml/kg saline increases PAWP, more in post-capillary PH than in pre-capillary PH or no-PH controls. A cut-off value of 18 mmHg allows to re-classify 6-8% of patients with pre-capillary PH or normal hemodynamics at baseline.


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