CC BY 4.0 · Avicenna J Med 2023; 13(02): 104-110
DOI: 10.1055/s-0043-1769932
Original Article

Importance of the Mean Rate of Pressure Change of the Pulmonary Artery (dP/dt mean PA) in Patients with Pulmonary Arterial Hypertension

Theodoros Sinanis
1   Department of Cardiology, Heart Center Duisburg, Duisburg, Germany
Alexander Schmeißer
2   Department of Cardiology, University Clinic Magdeburg, Magdeburg, Germany
› Author Affiliations


Background Pulmonary arterial hypertension (PAH) is a rare disease of cardiopulmonary circulation characterized by elevated pressure in the pulmonary artery. The right-heart catheter is the gold standard for diagnosis, but there is interest in identifying additional prognostic indicators. The aim of this study was to examine the importance of the rate of pressure change of the pulmonary artery (dP/dt mean PA) in patients with PAH.

Methods We retrospectively analyzed data from 142 patients with PAH (exclusively clinical group 1) and examined the statistical correlation of dP/dt mean PA with vascular, right ventricular, and clinical parameters. Data was collected mostly from the right heart catheterization and the transthoracal echocardiography at presentation.

Results dP/dt mean PA showed a significant correlation with systolic pressure of the pulmonary artery (n= 142, R 2 = 56%, p < 0.001), pulmonary vascular resistance (n = 142, R 2 = 51%, p < 0.001), the rate of pressure change in the right ventricle (n = 142, R 2 = 53%, p < 0.001), and the right ventricular fractional area change (n = 110, R 2 = 51%, p < 0.001). Receiver operating characteristic curve analysis showed that dP/dt mean PA had the highest prognostic value in predicting increase in the 6-minute walk test and decrease in the N-terminal-probrain natriuretic peptide after the initiation of PAH therapy, with an area under the curve of 0.73.

Conclusion Our findings suggest that dP/dt mean PA may be a useful prognostic indicator in the treatment of patients with PAH, and further research is warranted to validate this parameter.

Supplementary Material

Publication History

Article published online:
20 June 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Humbert M, Sitbon O, Chaouat A. et al. Pulmonary arterial hypertension in France: results from a national registry. Am J Respir Crit Care Med 2006; 173 (09) 1023-1030
  • 2 Simonneau G, Gatzoulis MA, Adatia I. et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 2013; 62 (25, Suppl): D34-D41
  • 3 Galiè N, Humbert M, Vachiery JL. et al; ESC Scientific Document Group. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 2016; 37 (01) 67-119
  • 4 Westerof N, Stergiopulos N, Noble M. Snapshots of Hemodynamics. 2nd ed.. Springer; 2010: 3-155
  • 5 Laurent S, Cockcroft J, Van Bortel L. et al; European Network for Non-invasive Investigation of Large Arteries. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006; 27 (21) 2588-2605
  • 6 Lee HY, Oh BH. Aging and arterial stiffness. Circ J 2010; 74 (11) 2257-2262
  • 7 Chirinos JA, Akers SR, Vierendeels JA, Segers P. A unified mechanism for the water hammer pulse and pulsus Bisferiens in severe aortic regurgitation: insights from wave intensity analysis. Artery Res 2018; 21: 9-12
  • 8 Masutani S, Iwamoto Y, Ishido H, Senzaki H. Relationship of maximum rate of pressure rise between aorta and left ventricle in pediatric patients. Implication for ventricular-vascular interaction with the potential for noninvasive determination of left ventricular contractility. Circ J 2009; 73 (09) 1698-1704
  • 9 Michelfelder EC, Vermilion RP, Ludomirsky A, Beekman RH, Lloyd TR. Comparison of simultaneous Doppler- and catheter-derived right ventricular dP/dt in hypoplastic left heart syndrome. Am J Cardiol 1996; 77 (02) 212-214
  • 10 Sade LE, Ozin B, Ulus T. et al. Right ventricular contractile reserve in mitral stenosis: implications on hemodynamic burden and clinical outcome. Int J Cardiol 2009; 135 (02) 193-201
  • 11 Ameloot K, Palmers PJ, Vande Bruaene A. et al. Clinical value of echocardiographic Doppler-derived right ventricular dp/dt in patients with pulmonary arterial hypertension. Eur Heart J Cardiovasc Imaging 2014; 15 (12) 1411-1419
  • 12 Tartière JM, Tabet JY, Logeart D. et al. Noninvasively determined radial dP/dt is a predictor of mortality in patients with heart failure. Am Heart J 2008; 155 (04) 758-763
  • 13 Liu SF, Nambiar Veetil N, Li Q, Kucherenko MM, Knosalla C, Kuebler WM. Pulmonary hypertension: linking inflammation and pulmonary arterial stiffening. Front Immunol 2022; 13: 959209 DOI: 10.3389/fimmu.2022.959209.
  • 14 Stergiopulos N, Westerhof BE, Westerhof N. Total arterial inertance as the fourth element of the windkessel model. Am J Physiol 1999; 276 (01) H81-H88
  • 15 Naeije R, Brimioulle S, Dewachter L. Biomechanics of the right ventricle in health and disease (2013 Grover Conference series). Pulm Circ 2014; 4 (03) 395-406
  • 16 Channick RN, Simonneau G, Sitbon O. et al. Effects of the dual endothelin-receptor antagonist bosentan in patients with pulmonary hypertension: a randomised placebo-controlled study. Lancet 2001; 358 (9288): 1119-1123
  • 17 Oudiz RJ, Brundage BH, Galiè N. et al; PHIRST Study Group. Tadalafil for the treatment of pulmonary arterial hypertension: a double-blind 52-week uncontrolled extension study. J Am Coll Cardiol 2012; 60 (08) 768-774
  • 18 Galiè N, Brundage BH, Ghofrani HA. et al; Pulmonary Arterial Hypertension and Response to Tadalafil (PHIRST) Study Group. Tadalafil therapy for pulmonary arterial hypertension. Circulation 2009; 119 (22) 2894-2903
  • 19 Ghofrani HA, Galiè N, Grimminger F. et al; PATENT-1 Study Group. Riociguat for the treatment of pulmonary arterial hypertension. N Engl J Med 2013; 369 (04) 330-340
  • 20 Semen K, Yelisyeyeva O, Jarocka-Karpowicz I. et al. Sildenafil reduces signs of oxidative stress in pulmonary arterial hypertension: Evaluation by fatty acid composition, level of hydroxynonenal and heart rate variability. Redox Biol 2016; 7: 48-57
  • 21 Galiè N, Ghofrani HA, Torbicki A. et al; Sildenafil Use in Pulmonary Arterial Hypertension (SUPER) Study Group. Sildenafil citrate therapy for pulmonary arterial hypertension. N Engl J Med 2005; 353 (20) 2148-2157
  • 22 Oudiz RJ, Galiè N, Olschewski H. et al; ARIES Study Group. Long-term ambrisentan therapy for the treatment of pulmonary arterial hypertension. J Am Coll Cardiol 2009; 54 (21) 1971-1981
  • 23 Galiè N, Olschewski H, Oudiz RJ. et al; Ambrisentan in Pulmonary Arterial Hypertension, Randomized, Double-Blind, Placebo-Controlled, Multicenter, Efficacy Studies (ARIES) Group. Ambrisentan for the treatment of pulmonary arterial hypertension: results of the ambrisentan in pulmonary arterial hypertension, randomized, double-blind, placebo-controlled, multicenter, efficacy (ARIES) study 1 and 2. Circulation 2008; 117 (23) 3010-3019
  • 24 Frost AE, Badesch DB, Barst RJ. et al. The changing picture of patients with pulmonary arterial hypertension in the United States: how REVEAL differs from historic and non-US Contemporary Registries. Chest 2011; 139 (01) 128-137
  • 25 Mathai SC, Puhan MA, Lam D, Wise RA. The minimal important difference in the 6-minute walk test for patients with pulmonary arterial hypertension. Am J Respir Crit Care Med 2012; 186 (05) 428-433
  • 26 Nakamura T, Uematsu M, Deyama J. et al. Pulmonary vascular resistance is associated with brachial-ankle pulse-wave velocity and adverse clinical outcomes in patients with heart failure with preserved ejection fraction. J Card Fail 2019; 25 (09) 725-732
  • 27 Hubbard JW, Cox RH, Sanders BJ, Lawler JE. Changes in cardiac output and vascular resistance during behavioral stress in the rat. Am J Physiol 1986; 251 (1 Pt 2): R82-R90
  • 28 Guihaire J, Haddad F, Boulate D. et al. Non-invasive indices of right ventricular function are markers of ventricular-arterial coupling rather than ventricular contractility: insights from a porcine model of chronic pressure overload. Eur Heart J Cardiovasc Imaging 2013; 14 (12) 1140-1149
  • 29 Humbert M, Kovacs G, Hoeper MM. et al; ESC/ERS Scientific Document Group. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2022; 43 (38) 3618-3731