Right heart catheterisation interpretation (PAWP, PVR, cardiac index) in HFpEF vs pulmonary hypertension
Core concept
- RHC answers three questions in sequence
- 1. Is there pulmonary hypertension? - mPAP >20 mmHg
- 2. Is it pre- or post-capillary? - PAWP (the surrogate for LV end-diastolic pressure)
- 3. Is there a pulmonary vascular component? - PVR
- PVR = (mPAP - PAWP) / CO in Wood units
| Class | mPAP | PAWP | PVR | Meaning |
|---|---|---|---|---|
| Pre-capillary | >20 | <=15 | >2 WU | PAH (group 1), lung disease (3), CTEPH (4) |
| Isolated post-capillary (IpcPH) | >20 | >15 | <=2 WU | Left heart disease alone - HFpEF, HFrEF, valve disease |
| Combined pre- and post-capillary (CpcPH) | >20 | >15 | >2 WU | Left heart disease plus pulmonary vascular remodelling - worse prognosis |
| Unclassified | >20 | <=15 | <=2 | High flow (shunt, anaemia, thyrotoxicosis, liver disease) |
| Exercise PH | mPAP/CO slope >3 mmHg/L/min |
- *The wedge pressure is the single measurement the diagnosis turns on* - and the one most often wrong
3 more sections, plus exam facts
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