American Heart Association

Pulmonary Hypertension

Hemodynamic measurements using QRS gating may more accurately classify pulmonary hypertension in heart transplant candidates

Contributor: Elise Vo

We’re talking Group 2 PAH here.  Diastolic pressure difference (DPD) [diastolic pulmonary artery pressure (dPAP) minus pulmonary capillary wedge pressure (PCWP)] identifies isolated post capillary pulmonary hypertension (Ipc-PH) (DPD ≤ 7 mmHg) in group 2 patients.  A diastolic pressure difference of > 7 mmHg defines combined pre-post capillary pulmonary hypertension (Cpc-PH)). Prior to heart transplantation, classification of pulmonary hypertension as Ipc-PH or Cpc-PH is important. Unlike Ipc-PH, Cpc-PH is associated with increased morbidity and mortality related to right ventricular graft failure post heart transplant. Even in the hands of seasoned invasive hemodynamic practitioners, measurement of DPD may not be as straightforward as it seems. Those tracings move, and these pressure differences are small!

Decoupling between dPAP and PCWP predicts mortality and HF readmission among CF-LVAD patients

Contributor: Elise Vo

Decoupling of diastolic pulmonary artery pressure and PCWP (greater than 5 mmHg difference) during ramp testing in continuous flow LVAD patients is a significant predictor for HF hospitalization and all-cause mortality. This decoupling is also represented as the diastolic pressure gradient (dPAP-PCWP). dPAP and PCWP decoupling (increased DPG) may indicate intrinsic pulmonary vascular pathology and associated right ventricular strain.