A64 LET'S GO TRIPPIN': DIAGNOSTICS AND RISK ASSESSMENT IN PULMONARY HYPERTENSION / Thematic Poster Session / Sunday, May 20/9:15 AM-4:15 PM / Area B (Hall A-B2, Ground Level) - San Diego Convention Center
Hemodynamic Response to Provocative Maneuvers During Right Heart Catheterization A. Arunachalam, A. Bhattacharyya, F. Qadir, R. Khan, T. Naal, B. J. Abuhalimeh, A. R. Tonelli, N. F. Chaisson; Respiratory Institute, Cleveland Clinic, Cleveland, OH, United States. Corresponding author's email:
[email protected] 1. Rationale: Several authors have proposed using provocative maneuvers during right heart catheterization (RHC) to facilitate accurate diagnosis of pre- and post-capillary pulmonary hypertension. Passive leg raising (PLR), submaximal exercise and fluid challenge have been described as suitable provocative maneuvers. In practice, providers often use these tests interchangeably, depending on patient characteristics and available resources during RHC. Although physiologically plausible, it is unclear whether changes associated with one provocative maneuver are indeed seen across a spectrum of maneuvers. We sought to compare the hemodynamic effects of various provocative maneuvers in patients referred for RHC. 2. Methods: We prospectively evaluated adult patients referred for RHC. After collecting baseline hemodynamic data, each patient underwent a protocol which included 3 provocative maneuvers: PLR (45-degree angle for 1 minute), submaximal graded exercise on supine bicycle (up to 40 Watts) and fluid challenge (500 mL of normal saline administered over 5 minutes). Descriptive statistics included counts and percentages. We used Pearson’s correlation coefficient to assess the strength and direction of a linear relationship between provocative maneuvers. The correlation was assessed for six hemodynamic parameters commonly assessed during provocative RHC maneuvers. These included changes in right atrial pressure (ΔRAP), mean pulmonary artery pressure (ΔmPAP), pulmonary artery wedge pressure (ΔPAWP), cardiac index (ΔCI), pulmonary artery compliance (ΔPAC) and pulmonary vascular resistance (ΔPVR). 3. Results: Forty patients were included (age 61±12 years, 47% females). Baseline hemodynamics showed a RAP of 7±2mmHg, mPAP of 27±7mmHg, PAWP of 12±4mmHg, PAC 4.36±2.03 mL/mmHg, CI of 2.77±0.61 L/min/m2 and a PVR of 2.96±2.31 Wood units. Notably, graded exercise up to 40 Watts and fluid challenge were highly correlated for ΔRAP(r=0.79, p=
