CHEST Guidelines-Systolic and Mean Pulmonary Artery Pressures

Systolic and Mean Pulmonary Artery Pressures

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This document discusses the relationship between systolic pulmonary artery pressure (sPAP) and mean pulmonary artery pressure (mPAP) in diagnosing pulmonary hypertension (PH). It highlights the challenge of accurately estimating mPAP from sPAP values, which has been shown to have a strong linear relationship, contrary to traditional physiological expectations. The study emphasizes the use of an empirical formula to estimate mPAP from sPAP (mPAP = 0.61 sPAP + 2 mm Hg), demonstrating high accuracy across different patient groups, including those with chronic thromboembolic pulmonary hypertension (CTEPH) and idiopathic pulmonary arterial hypertension (iPAH).<br /><br />The manuscript, authored by Denis Chemla and colleagues, asserts that the 25 mm Hg threshold for defining PH aligns with an sPAP of 38 mm Hg. This finding is significant for noninvasively diagnosing PH since it may provide a more reliable estimate of mPAP using echocardiographic measurements. The commentary discusses two main aims: summarizing the strong correlation between mPAP and sPAP and examining the implications for PH diagnosis and pathophysiology.<br /><br />The study uses both high-fidelity micromanometer-tipped pulmonary artery catheters and fluid-filled catheters to validate the empirical relationship, noting consistent results across a range of physiological variables and patient demographics. It highlights the potential inaccuracies of echocardiographic sPAP estimates and suggests a multiparameter echocardiographic approach for diagnosing PH. The commentary also calls for further invasive studies to refine the precision of mPAP estimates derived from sPAP and to explore its implication fully.<br /><br />This research highlights the potential to identify PH noninvasively, offering new perspectives on pulmonary circulation and arterial pressure relationships, with emphasis on their operational relevance in clinical practice.

Keywords

systolic pulmonary artery pressure

mean pulmonary artery pressure

pulmonary hypertension

diagnosis

empirical formula

echocardiographic measurements

chronic thromboembolic pulmonary hypertension

idiopathic pulmonary arterial hypertension

Denis Chemla

noninvasive diagnosis