Measuring Pulmonary Artery Pressures in Heart Failure
A New Useful Diagnostic Tool?
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Article, see p 1509
Heart failure (HF) remains one of the largest health problems in the Western world that caused an estimated 37.6 million HF or HF-related hospitalizations in the United States between 2001 and 2009.1 After an insult to the myocardium, cardiac output drops, which will lead to impairment of the systemic circulation and ultimately signs and symptoms of HF. Indeed, tissue and organ perfusion generally decreases in HF, despite the fact that local compensatory mechanisms are activated. To maintain sufficient perfusion of vital organs and peripheral tissues, vasoconstrictor mechanisms in the systemic arterial bed become active in response to stimulation of the sympathetic nervous and renin-angiotensin system.2 This has paved the way for the use of arterial vasodilators in HF because long-term systemic vasoconstriction leads to left ventricular hypertrophy and failure and ultimately refractory HF. As a consequence of left-sided HF, pulmonary congestion may occur. Previously, pulmonary congestion was considered mainly a marker of severity of left-sided HF, but there is increasing evidence that pulmonary congestion may also be actively contributing to the HF syndrome and impair prognosis.3
Along with previous attempts to indirectly monitor signs related to pulmonary congestion in HF,4 there is a (renewed) interest in more directly measuring pulmonary artery (PA) pressures in HF. Moreover, elevated PA pressures have been shown to strongly associate with an adverse prognosis and increased risk for hospitalization in patients with HF (Figure).5 For this reason, the pulmonary circulation as a therapeutic target in HF has gained increasing interest in recent years.