Fluid challenge predicts clinical worsening in pulmonary arterial hypertension. (15th June 2018)

• Record Type: Journal Article
• Authors: D'Alto, Michele; Motoji, Yoshiki; Romeo, Emanuele; Argiento, Paola; Di Marco, Giovanni Maria; Mattera Iacono, Agostino; D'Andrea, Antonello; Rea, Gaetano; Golino, Paolo; Naeije, Robert
• Is Part Of: International journal of cardiology. Volume 261(2018)
• Page Start: 167
• Page End: 171
• Publication Date: 2018-06-15
• Subjects: CI cardiac index -- CO cardiac output -- dPAP diastolic pulmonary artery pressure -- FC functional class -- mPAP mean pulmonary artery pressure -- PAC pulmonary arterial compliance -- PAH pulmonary arterial hypertension -- PAP pulmonary artery pressure -- PAWP pulmonary artery wedge pressure -- PH pulmonary hypertension -- PVR pulmonary vascular resistance -- RAP right atrial pressure -- RV right ventricle -- sPAP systolic pulmonary artery pressure -- SV stroke volume -- SVI stroke volume index -- WHO World Health Organization; Pulmonary hypertension -- Fluid challenge -- Prognosis; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.03.020
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Aim: A fluid challenge with rapid saline infusion during right heart catheterization has been shown to be useful for the differential diagnosis between pre- and post-capillary pulmonary hypertension. The aim of this study was to evaluate the prognostic relevance of fluid challenge-induced changes in pulmonary hemodynamics in patients with pulmonary arterial hypertension (PAH). Methods: Overall, 118 PAH patients (mean age 57 ± 15 years, 80 female) underwent hemodynamic measurements before and after rapid saline infusion (7 mL/kg in 10 min) and were followed up for 19 ± 4 months. Results: Thirty-two patients (27%) had a clinical worsening event defined as the occurrence of one of the following: death, lung transplantation, initiation of parenteral prostanoids, or worsening of PAH (defined as the presence of all of the three following components: a decrease in the 6-minute walk distance of at least 15% from baseline, worsening of PAH symptoms, and need for new PAH treatment). Cardiac index (CI), stroke volume and pulmonary artery compliance were lower whereas right atrial pressure (RAP), the ratio of RAP to pulmonary artery wedge pressure (PAWP) and pulmonary vascular resistance were higher in patients with a clinical worsening event versus patients without events, both at baseline and after fluid challenge (all p < 0.01). At multivariable Cox proportional hazards regression analysis, a post-fluid challenge CI <2.8 L/min/m 2 (hazard ratio 0.0143; 95% confidence interval 0.006–0.3383; p = 0.009) was the only independent predictor of outcome. Conclusions: CI measured after a fluid challenge is an independent predictor of outcome in PAH. Highlights: A fluid challenge is useful for the differential diagnosis between pre- and post-capillary PH. A fluid challenge could be considered as a test of right ventricle preload reserve. A post-fluid challenge cardiac index <2.8 L/min/m 2 predicted clinical worsening in PAH.