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Right-Heart Catheterization in Coronary Artery Disease

Veterans Administration Hospital, Bronx, New York, Department of Medicine, Mount Sinai School of Medicine (CUNY), New York, New York

The performance of routine right-heart catheterization on patients under going study for coronary artery disease is a subject of controversy. Accordingly, data from 100 consecutive patients who had coronary arteriography and right- heart catheterization were analyzed. Seventy-nine had significant (>70% ste nosis) coronary disease (group I), and 21 had patent coronary vessels (group II). Although group I patients had a lower ejection fraction (EF) 53 ± 2 vs 65 ± 2%, P < 0.05) and stroke work index (SW) (52 ± 2.2 vs 69 ±4.2 Gm-m/m², P < 0.001) than group II patients, systolic pulmonary artery (PA) pressure (31 ± 1.6 vs 26 ± 1.2 mmHg, NS), pulmonary arteriolar resistance (PAR) (2.3 ± 0.2 vs 1.7 ± 0.2 u,NS), and cardiac index (CI) (3.1 ± 0.3 vs 3.1 ± 0.2 L/min/m², NS) were not different.

Systolic PA pressure in group I correlated with left ventricular end-diastolic pressure (LVEDP), SW, and EF, but these relationships were not strong (r < 0.57, all P < 0.01). Eight patients had a PA pressure greater than 50 mm Hg (66 ± 3.8 mm Hg). All had multivessel disease, extensive asynergy, significant mitral regurgitation, and severe left ventricular dysfunction (CI: 2.2 ± 0.3 L/ min/m²; LVEDP: 33 ± 2 mm Hg; SW: 28 ± 5.5 gm-m/m² ; EF: 25 + 2%); all were considered inoperable. Six other group I patients also had an EF less than 30% but had lower systolic PA pressures. Four of these had hemodynamic findings indistinguishable from those with severe PA hypertension, whereas 2 had localized aneurysms and no mitral regurgitation, and both survived an open-heart operation.

Thus this study supports the view that routine right-heart catheterization in coronary artery disease does not provide additional information that might help in determining patient prognosis or suitability for coronary by-pass surgery.

Angiology, Vol. 29, No. 12, 878-887 (1978)
DOI: 10.1177/000331977802901202


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