• Mazen O Al-Qadi, Jason Holbrook, H James Ford, Agathe Ceppe, and Barbara L LeVarge.
• Division of Pulmonary and Critical Care Medicine and Pulmonary Hypertension Program, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: mazen_al-qadi@med.unc.edu.
• Chest. 2023 Aug 1; 164 (2): 481489481-489.

BackgroundPrecapillary pulmonary hypertension is characterized by elevated mean pulmonary artery pressure from increased pulmonary vascular resistance. Lack of respiratory variation in right atrial pressure can be viewed as a surrogate for severe pulmonary hypertension and inability of the right ventricle to tolerate preload augmentation during inspiration.Research QuestionIs the lack of respiratory variation in right atrial pressure predictive of right ventricular dysfunction and worse clinical outcomes in precapillary pulmonary hypertension?Study Design And MethodsWe retrospectively reviewed right atrial pressure tracings of patients with precapillary pulmonary hypertension who underwent right heart catheterization. Patients with respiratory variation in right atrial pressure (end expiratory-end inspiratory) ≤ 2 mm Hg were considered to have effectively no meaningful variation in right atrial pressure.ResultsLack of respiratory variation in right atrial pressure was associated with lower cardiac index by indirect Fick (2.34 ± 0.09 vs 2.76 ± 0.1 L/min/m2; P = .001), lower pulmonary artery saturation (60% ± 1.02% vs 64% ± 1.15%; P = .007), higher pulmonary vascular resistance (8.9 ± 0.44 vs 6.1 ± 0.49 Wood units, P < .0001), right ventricular dysfunction on echocardiography (87.3% vs 38.8%; P < .0001), higher pro brain natriuretic peptide (2,163 ± 2,997 vs 633 ± 402 ng/mL; P < .0001), and more hospitalizations within 1 year for right ventricular failure (65.4% vs 29.6%; P < .0001). There was also a trend toward higher mortality at 1 year in patients with no respiratory variation in right atrial pressure (25.4% vs 11.1%; P = .06).InterpretationLack of respiratory variation in right atrial pressure is associated with poor clinical outcomes, adverse hemodynamic parameters, and right ventricular dysfunction in patients with precapillary pulmonary hypertension. Larger studies are needed to further evaluate its utility in prognosis and potential risk stratification in patients with precapillary pulmonary hypertension.Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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