Source: Annual Congress 2006 - Pulmonary hypertension: thromo-embolic processes
Disease area: Pulmonary vascular diseases

Abstract

Patients with proximal obstruction in the pulmonary vascular bed have been reported to have higher pulmonary artery pulse pressures than those with distal obstruction. We have retrospectively reviewed all subjects diagnosed with CTEPH in our unit since 2001 and compared those classified as either proximal or distal disease. Data were available for 92 subjects (73 proximal disease). 55 were female and the median age was 60.5 years (range 21-83). There was no significant difference between proximal and distal disease in terms of mean right atrial pressure (7 versus 9 mmHg), mean pulmonary artery pressure (46 versus 47 mmHg), pulmonary artery pulse pressure (52 versus 46.5 mmHg), pulmonary vascular resistance (750 versus 817.5 dynes.s.cm^-5), cardiac index (2.2 versus 2.3 L.min^-1.m^-2), mixed venous oxygen saturation (61.4 % versus 60.0%), exercise capacity assessed by incremental shuttle walking test (130m versus 120m) or gas transfer (65.2% predicted versus 68.4%). 23 subjects with proximal disease and 8 with distal had a cardiac index of less than 2.1 L.min^-1.m^-2 suggesting significantly impaired right ventricular function. Analysis of the data excluding these subjects revealed significantly higher pulmonary artery pressures (PAP) in those with proximal disease. This was true for systolic PAP (75 versus 61.5 mmHg, p = 0.01) and mean PAP (47 versus 37 mmHG, p = 0.01) but not diastolic PAP (27 versus 21.5 mmHG, p = 0.17). This resulted in a greater pulmonary artery pulse pressure in those with proximal disease (53 versus 39 mmHg, p = 0.01). We conclude that in patients with CTEPH and preserved right ventricular function, proximal disease is associated with higher pulmonary artery pulse pressures.

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Citations should be made in the following way:
R. Barraclough, C. Elliot, I. Armstrong, C. Billings, C. Ward, D. Kiely (Sheffield, United Kingdom). Pulmonary artery pulse pressure in chronic thromboembolic pulmonary hypertension (CTEPH). Eur Respir J 2006; 28: Suppl. 50, 2356

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