Pulmonary Capillary Wedge Pressure Augments Right Ventricular Pulsatile Loading

• DOI: 10.1161/circulationaha.111.051540
• Publication Date: 2011-12-02T09:17:44Z
• Authors: Ryan J. Tedford; Paul M. Hassoun; Stephen C. Mathai; Reda E. Girgis; Stuart D. Russell; David R. Thiemann; Oscar H. Cingolani; James O. Mudd; Barry A. Borlaug; Margaret M. Redfield; David J. Lederer; David A. Kass
• Keywords: Pulmonary wedge pressure; Pulsatile flow

Background— Right ventricular failure from increased pulmonary vascular loading is a major cause of morbidity and mortality, yet its modulation by disease remains poorly understood. We tested the hypotheses that, unlike systemic circulation, resistance (R PA ) compliance (C are consistently inversely related regardless age, hypertension, or interstitial fibrosis that this relation may be changed elevated capillary wedge pressure, augmenting right pulsatile load. Methods Results— Several large clinical databases with heart/pulmonary catheterization data were analyzed to determine R -C relationship fibrosis, patient varying pressure. Patients suspected documented hypertension (n=1009) normal pressure displayed consistent hyperbolic (inverse) dependence, C =0.564/(0.047+R ), near-constant resistance-compliance product (0.48±0.17 seconds). In same patients, was highly variable. Severe (n=89) did not change relation. Increasing age led very small but statistically significant in However, elevation (n=8142) had larger impact, significantly lowering for any negatively correlating ( P <0.0001). Conclusions— Pulmonary do dependence between , has only minimal effects. This fixed helps explain difficulty reducing total afterload therapies have modest impact on mean . Higher appears enhance net elevating pulsatile, relative resistive, load contribute dysfunction.