Pulmonary hemodynamics in primary pulmonary hypertension.

Abstract

One hundred and thirteen cases of primary pulmonary hypertension (PPH) obtained through a questionnaire survey to various nation-wide institutions were investigated. They are divided into 2 groups: the survivors (48 cases) and those who died (65 cases). The relation between the hemodynamic parameters and the survival months after right heart catheterization was examined. The results can be summarized as follows:1) In all PPH cases, the average cardiopulmonary pressures were 8.3±6.4mmHg in PRA, 62.3±17.3mmHg in PPA, and 7.4±4.1mmHg in PPC. There were no statistically significant differences in these parameters between the survivors and the deceased. There was no fixed relation between the cardiopulmonary pressures and the survival time after the measurement.2) The average CI was 2.90±0.95L/min/M2 as a whole. For the survivor group it was 3.29±1.13 and for the deceased group 2.60±0.69L/min/M2, the latter showing a significantly lower value (p<0.001). There was also a significant positive correlation (r=0.484, p<0.01) between CI and the survival months from the date CI was measured.3) The TPVR was 1, 362±704 dyne sec cm-5, which was a remarkably increased value. The value for the deceased group was much higher than that of the survivor group (p<0.001).4) The RVWI was 2.05±0.99Kg/min/M2 as a whole. The value for the deceased group was clearly lower than that of the survivor group (P<0, 001).5) As to arterial blood gas data, SaO2 was 90.7±5.8%, PaO2 67.9±17.0mmHg, PaCO2 32.0±8.4mmHg, and pH 7.45±0.05 as a whole. The PaO2 of 73.4±13.8mmHg for the survivors was clearly higher than that of 64.2±18.6mmHg for the deceased group (p<0.001).6) There were no fixed trends between any of the hemodynamic parameters. However, the prognosis was extremely poor in cases with PPA_??_50mmHg and CI_??_2.8L/min/M2, PRA_??_6mmHg and RVWI_??_2Kgm/min/M2, and PaO2_??_70mmHg.From the above results, it is evident that right heart failure is decisive of the poor prognosis of PPH and this is most clearly expressed by the decreased CI. In addition, the presence of hypoxia is also considered to affect the prognosis.