1. Clinical Relevance of Fluid Challenge in Patients Evaluated for Pulmonary Hypertension
- Author
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Anna Correra, Paola Argiento, Berardo Sarubbi, Antonello D'Andrea, Yoshiki Motoji, Emanuele Romeo, Michele D'Alto, Agostino Mattera Iacono, Giovanni Maria Di Marco, Rosaria Barracano, Robert Naeije, Maria Giovanna Russo, Gaetano Rea, D'Alto, M., Romeo, E., Argiento, P., Motoji, Y., Correra, A., Di Marco, G. M., Iacono, A. M., Barracano, R., D'Andrea, A., Rea, G., Sarubbi, B., Russo, M. G., and Naeije, R.
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Cardiac Catheterization ,Pulmonary Circulation ,Hypertension, Pulmonary ,Hemodynamics ,heart failure ,Reproducibility of Result ,030204 cardiovascular system & hematology ,Sodium Chloride ,Critical Care and Intensive Care Medicine ,heart catheterization ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine.artery ,pulmonary hypertension ,medicine ,Humans ,Prospective Studies ,Infusions, Intravenou ,Pulmonary Wedge Pressure ,Infusions, Intravenous ,Pulmonary wedge pressure ,Fluid Shifts ,Aged ,business.industry ,Central venous pressure ,Reproducibility of Results ,Fluid Shift ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,fluid challenge ,Prospective Studie ,medicine.anatomical_structure ,030228 respiratory system ,Heart failure ,Heart catheterization ,Pulmonary artery ,Vascular resistance ,Cardiology ,Female ,Vascular Resistance ,Cardiology and Cardiovascular Medicine ,business ,Human - Abstract
Background Fluid challenge may help in the differential diagnosis between pre- and postcapillary pulmonary hypertension (PH). However, the test is still in need of standardization and better defined clinical relevance. Methods Two hundred twelve patients referred for PH underwent a right-sided heart catheterization with measurements before and after rapid infusion of 7mL/kg of saline. PH was defined as mean pulmonary artery pressure≥ 25mmHg, and postcapillary PH was defined as pulmonary artery wedge pressure (PAWP) > 15mmHg. An increase in PAWP≥ 18mmHg was considered diagnostic for postcapillary PH. At baseline, 66 patients received a diagnosis of no PH; 22, of postcapillary PH; and 124, of precapillary PH (mostly pulmonary arterial hypertension). Results After fluid challenge, five of 66 patients with no PH (8%) and eight of 124 with precapillary PH (6%) had the diagnosis reclassified as postcapillary PH. Fluid challenge was associated with an increase in PAWP by 7 ± 2mmHg in postcapillary PH and 3 ± 1mmHg in both precapillary PH and no-PH groups. 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 control subjects with no PH and patients with precapillary PH helped confirm 18mmHg as the cutoff for diagnosing postcapillary PH. Conclusions Fluid challenge with 7mL/kg saline increases PAWP, more in postcapillary than in precapillary PH or in control subjects with no PH. A cutoff value of 18mmHg allows reclassification of 6%to 8%of patients with precapillary PH or normal hemodynamic characteristics at baseline.
- Published
- 2017