Relation of pulmonary arterial diastolic and mean pulmonary arterial wedge pressures in patients with and without pulmonary hypertension

Abstract

Management of the critically ill or postoperative patient in the intensive care unit may be facilitated by the measurement of right-sided and certain left-sided intracardiac filling pressures with a balloon-tipped, flow-directed catheter. Although previous studies have shown that properly obtained and oximetrically confirmed pulmonary arterial wedge pressure provides an accurate estimate of left atrial pressure, 1 Werko L. Varnauskas E. Eliasch H. Lagerlof H. Senning A. Thommasson B. Further evidence that the pulmonary capillary venous pressure pulse in man reflects cyclic pressure changes in the left atrium. Circ Res. 1953; 1: 337-344 Crossref PubMed Scopus (28) Google Scholar , 2 Connolly D.C. Kirklin J.W. Wood E.H. The relationship between pulmonary artery wedge pressure and left atrial pressure in man. Circ Res. 1953; 2: 434-440 Crossref Scopus (75) Google Scholar , 3 Lange R.A. Moore D.M. Cigarroa R.G. Hillis L.D. Use of pulmonary capillary wedge pressure to assess severity of mitral stenosis Is true left atrial pressure needed in this condition?. J Am Coll Cardiol. 1953; 13: 825-829 Abstract Full Text PDF Scopus (55) Google Scholar the procurement of an oximetrically confirmed wedge pressure may be difficult or impossible in some subjects. As a result, some investigators 4 Lipp-Ziff E.L. Kawanishi D.T. A technique for improving the accuracy of pulmonary artery diastolic pressure as an estimate of left ventricular end-diastolic pressure. Heart Lung. 1953; 20: 107-115 Google Scholar have suggested that pulmonary arterial diastolic pressure can be used as a surrogate for mean pulmonary arterial wedge pressure and, in turn, mean left atrial pressure. In 28 patients with varied pulmonary vascular resistances, Jenkins et al 5 Jenkins B.S. Bradley R.D. Branthwaite M.A. Evaluation of pulmonary arterial end-diastolic pressure as an indirect estimate of left atrial mean pressure. Circulation. 1953; 152: 75-78 Google Scholar demonstrated an excellent correlation between pulmonary arterial diastolic and mean left atrial pressures. Despite these reports, no previously published study has assessed the relation of pulmonary arterial diastolic to mean pulmonary arterial wedge pressures in a large number of patients in whom the catheter’s wedge position was confirmed oximetrically. Accordingly, this study was performed to assess this relation and to determine if it is influenced by pulmonary hypertension.