Pulmonary Hemodynamics in Primary Pulmonary Hypertension

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Abstract
Cases (113) of primary pulmonary hypertension (PPH) were divided into 2 groups: the survivors (48 cases) and those who died (65 cases). The relation between the hemodynamic parameters and the months of survival after right heart catheterization was examined. In all PPH cases, the average cardiopulmonary pressures were 8.3 .+-. 6.4 mmHg in .hivin.PRA [mean right atrial pressure], 62.3 .+-. 17.3 mmHg in .hivin.PPA [pulmonary arterial pressure] and 7.4 .+-. 4.1 mmHg in .hivin.PPC [mean capillary pressure]. There were no statistically significant differences in these parameters between the survivors and the deceased. There was no fixed relation between the cardiopulmonary pressures and the survival time after the measurement. The average CI [cardiac index] was 2.90 .+-. 0.95 l/min per m2 as a whole. For the survivor group it was 3.29 .+-. 1.13 l/min per m2 and for the decreased group 2.60 .+-. 0.69 l/min per m2, the latter showing a significantly lower value (P < 0.001). There was also a significant positive correlation (r [correlation coefficient] = 0.484, P < 0.01) between CI and the survival months from the date CI was measured. The TPVR [total pulmonary vascular resistance] was 1362 .+-. 704 dyn.cntdot.s.cntdot.cm-5, which was a remarkably increased value. The value for the decreased group was much higher than that of the survivor group (P < 0.001). The RVWI [right ventricular work index] was 2.05 .+-. 0.99 kg/min per m2 as a whole. the value for the deceased group was clearly lower than that of the survivor group (P < 0.001). SaO2 [arterial O2 daturation] was 90.7 .+-. 5.8%, PaO2 [arterial O2 partial pressure] was 67.9 .+-. 17.0 mmHg, PaCO2 [arterial CO2 partial pressure] was 32.0 .+-. 8.4 mmHg, and pH was 7.45 .+-. 0.05. The PaO2 of 73.4 .+-. 13.8 mmHg for the survivors was clearly higher than that of 64.2 .+-. 18.6 mmHg for the deceased group (P < 0.001). There were no fixed trends between any of the hemodynamic parameters. The prognosis was extremely poor in cases with .hivin.PPA .gtoreq. 50 mmHg and CI .ltoreq. 2.8 l/min per m2, .hivin.PRA .gtoreq. 6 mmHg and RVWI .ltoreq. 2 kg/min per m2, and PaO2 .ltoreq. 70 mmHg. Right heart failure is decisive in the poor prognosis of PPH and this is most clearly expressed by the decreased CI. The presence of hypoxia also affects prognosis.