CHEST Guidelines-More-Than-a-Number

More-Than-a-Number_chest

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The article "More Than a Number: What We Can Learn From Hemodynamic Waveforms" highlights the evolving understanding and diagnostic utility of hemodynamic waveforms in patients with pulmonary hypertension (PH). Traditionally, numeric values obtained from right heart catheterization have been used for early diagnosis and risk stratification of PH. However, emerging evidence suggests that the characteristics of hemodynamic waveforms themselves provide additional clinically relevant data.<br /><br />One notable finding discussed is the presence of large V-waves on the pulmonary artery wedge pressure (PAWP) tracing, which suggests left-sided heart disease even if PAWP is below the standard cutoff. The study by Al-Qadi et al. demonstrates that the lack of respiratory variation in right atrial pressure (RAP) waveforms is associated with elevated right ventricular (RV) afterload and dysfunction, as well as higher natriuretic peptide levels and increased future hospitalizations for RV failure.<br /><br />This lack of respiratory variation in RAP is reminiscent of a hemodynamic Kussmaul's sign, traditionally associated with conditions like constrictive pericarditis and restrictive cardiomyopathy. The study further suggests that the presence of Kussmaul’s sign correlates more closely with RV afterload in precapillary PH.<br /><br />Additionally, waveform analysis can have implications for intra-atrial septal device therapies used in left-sided heart failure. Such devices aim to offload increased pressures by shunting blood, theoretically improving symptoms. The viability of this therapy seems linked to maintaining respiratory variation in pressure waveforms.<br /><br />Overall, the authors underscore the need to look beyond just numerical data in heart catheterization reports, suggesting that waveform characteristics can offer deeper insights into a patient's hemodynamic status and guide more informed clinical decisions. The study prompts further inquiry into these observations' prognostic value and their potential application across various PH scenarios.

Keywords

hemodynamic waveforms

pulmonary hypertension

right heart catheterization

V-waves

pulmonary artery wedge pressure

right atrial pressure

Kussmaul's sign

right ventricular afterload

intra-atrial septal device

waveform analysis