Pneumologie 2009; 63 - P252
DOI: 10.1055/s-0029-1214083

Non-invasive Hemodynamic Assessment in Patients with Pulmonary Hypertension

S Desole 1, C Seemann 1, P Heinniger 1, R Hiemetzberger 2, S Müller 2, C Kähler 1
  • 1Universitätsklinik für Innere Medizin I, Medical University of Innsbruck
  • 2Cardiology – Internal Medicine III, Department of Internal Medicine, Medical University of Innsbruck

Vascular remodelling of small vessels of the pulmonary circulation and consecutive right heart failure are the key features in the pathophysiology of pulmonary hypertension (PH). Until today invasive measurement of hemodynamics is indispensable for diagnosis and follow-up of this devasting disease.

Aim of the study was to evaluate security, reproducibility and feasibility of a new non-invasive hemodynamic method in patients with PH.

An inert gas rebreathing technique (Innocor®) was investigated in 30 patients (mean-age 65±12, m:f 10:20) with PH. Non-invasive hemodynamic assessment and invasive right heart catheterisation were performed in each patient. Additionally, NT-proBNP, transthoracic echo and the walking distance (SMWT) were determined.

The investigated method was secure in all patients. The directly measured parameter is the pulmonary blood flow (PBF; 3.52±1.35l/min). Reproducibility of measured PBF was very high with a coefficient of variation of repeated measurements being 0,11.

PBF correlated significantly with following invasively measured parameters: pulmonary vascular resistance (PVR;564,19±423,5 dynes*s/cm5; r=-0,502**), CO (Fick:4,14±1.88l/min, r=0,512**; Thermo:4,7±2,18, r=0,680**), mean pulmonary artery pressure (mPAP;41,57±15.09mmHg; r=-0,259*) but not with right atrial pressure (RA; 12,5±6.05mmHg). PBF correlated further with NT-pro BNP levels (1519,93±3067,19ng/l; r=-0,375**) and TEI index (0.51±0.2; r=-0,431**), but not with echo parameters like TAPSE (1.75±0.34) or estimated systolic PAP (66,81±19,02mmHg). No correlation between PBF and SMWT (308,3±177,9m) was observed.

Non-invasive determination of PBF correlated significantly with invasively measured hemodynamic parameters, i.e. PVR, CO and mPAP in PH patients. Furthermore, a correlation with right heart parameters (NT-pro-BNP and TEI) was seen. Further large prospective studies might reveal the feasibility of this new method for follow-up.