Through this narrative review, we attempt to outline relevant hemodynamic indices studied in PH ( Figure 1), including their description, normal values, use, and limitations as they apply to improving both the pathophysiological understanding and prognostic assessment in PH. A variety of other hemodynamic indices that provide information on different aspects of the pulmonary circulation have been explored in PH, but not yet incorporated into clinical practice. These tools use limited hemodynamic information including right atrial pressure (RAP), cardiac index (CI), and PVR. Commonly used tools include the French PH network registry assessment which incorporates data from up to six variables, and the US Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL) 2.0 risk equation that includes up to 13 variables ( 4- 6). Great emphasis has been placed on risk stratifying patients to guide treatment. Group 2 PH or PH resulting from left heart disease (PH-LHD) is characterized by postcapillary PH (PAWP >15 mmHg) and can be divided into 2 hemodynamic subgroups, isolated postcapillary PH (IpcPH) in which the PVR is <3 WU and combined pre- and post-capillary PH (CpcPH) in which the PVR is ≥3 WU ( 3). Group 1 PH or pulmonary arterial hypertension (PAH) is characterized by precapillary PH that can lead to right heart failure and death ( 2). PH is divided into 5 groups based on similar pathophysiological mechanisms, clinical presentation, hemodynamic characteristics, and therapeutic management ( 1). The pulmonary circulation is a low pressure and low resistance system however, in certain conditions the mean pulmonary artery pressure (mPAP) increases above 20 mmHg, leading to the diagnosis of pulmonary hypertension (PH). It includes a network of arteries, veins, and lymphatics whose main function is gas exchange. The pulmonary circulation starts in the right ventricle (RV), moves into the pulmonary arteries (PA), and extends through the pulmonary veins into the left atrium. Keywords: Pulmonary hypertension (PH) hemodynamic indices However, it remains important to develop and validate indices that provide a comprehensive hemodynamic evaluation to improve outcomes in patients with PH. We described the advantages and pitfalls of various indices, including when to use them in the hemodynamic evaluation of patients with PH.Ĭonclusions: A variety of indices measuring different aspects of the right ventricle (RV)-pulmonary arteries (PA) system provide valuable information in patients with PH. While some of these indices are routinely used in clinical practice, including cardiac index (CI), stroke volume (SV), and pulmonary vascular resistance (PVR) others such as pulmonary artery compliance (PAC), pulmonary effective arterial elastance (Ea), and pulmonary artery pulsatility index (PAPi) are gaining popularity by enhancing the understanding of different aspects of the pulmonary circulation. Key Content and Findings: In this article, we present both static and dynamic indices used for the hemodynamic assessment of PH. ![]() Methods: We performed a thorough literature search of relevant articles in English from 1970–2021 using PubMed. A multitude of indices assess different aspects of the pulmonary circulation but there are no reviews that describe their specific value in PH. A comprehensive hemodynamic evaluation of the pulmonary circulation is essential for diagnosis, hemodynamic classification, and prognostication. ^ORCID: Gaurav Manek, 0000-0003-4696-1352 Divyansh Bajaj, 0000-0002-7437-5599 Ankit Agrawal, 0000-0001-7885-6667.īackground and Objective: Pulmonary hypertension (PH) is defined as a mean pulmonary artery pressure (mPAP) >20 mmHg and its presence is associated with worse outcomes. #These authors contributed equally to this work and should be considered as co-first authors. Tonelli 1ġ Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA Ģ Department of Internal Medicine, University of Connecticut, Farmington, CT, USA ģ Department of Pulmonary, Critical Care and Sleep Medicine, Medical College of Wisconsin, Milwaukee, WI, USA Ĥ Division of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USAĬontributions: (I) Conception and design: G Manek, M Gupta, AR Tonelli (II) Administrative support: G Manek, M Gupta, AR Tonelli (III) Provision of study materials or patients: G Manek, M Gupta, AR Tonelli (IV) Collection and assembly of data: G Manek, M Gupta, A Agrawal, D Bajaj, M Chhabria (V) Data analysis and interpretation: AR Tonelli (VI) Manuscript writing: All authors (VII) Final approval of manuscript: All authors. Gaurav Manek 1#^, Manasvi Gupta 2#, Mamta Chhabria 1, Divyansh Bajaj 3^, Ankit Agrawal 4^, Adriano R.
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