Right-Heart Catheterization in Coronary Artery Disease

Abstract

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.

Get full access to this article

View all access options for this article.

References

Bruschke, A.V.G. , Proudfit, W.L. , Jones, F.M. , Jr.: Progress study of 590 consecutive nonsurgical cases of coronary disease followed 5-9 years. I. Arteriographic correlations. Circulation, 47: 1147-1153, 1973.

Bruschke, A.V.G. , Proudfit, W.L. , Jones, F.M. , Jr.: Progress study of 590 consectutive nonsurgical cases of coronary disease followed 5-9 years. II. Ventriculographic and other considerations. Circulation, 47: 1154-1163, 1963.

Snedecor, G.W. , Cochran, W.G. : Statistical Methods. Ames, Iowa, Iowa State University Press, 1967, pp. 91-119, 135-198.

Cohn, P.F. , Gorlin, R. , Herman, M.V. , et al.: Relation between contractile reserve and prognosis in patients with coronary artery disease and a depressed ejection fraction. Circulation, 51: 414-420, 1975.

Gorlin, R. : Coronary artery disease. Philadelphia, W. B. Saunders, 1976, p. 45.

Falicov, R.E. , Resnekov, L. : Relationship of the pulmonary artery end-diastolic pressure to the left ventricular end-diastolic and mean filling pressures in patients with and without left ventricular dysfunction. Circulation, 62: 65-73, 1970.

Bouchard, R.J. , Gault, J.H. , Ross, J. , Jr.: Evaluation of pulmonary arterial end-diastolic pressure as an estimate of left ventricular end-diastolic pressure in patients with normal and abnormal left ventricular performance. Circulation , 64: 1072-1079, 1971.

RaHimtoola, S.H. , Leob, H.S. , Ehsani, A. , et al.: Relationship of pulmonary artery to left ventricular diastolic pressures in acute myocardial infarction. Circulation, 66: 283-290, 1972.

Ferlinz, J. , Gorlin, R. , Cohn, P.F. , et al.: Right ventricular performance in patients with coronary artery disease. Circulation, 52: 608-615, 1975.

10.

Cohn, J.N. , Guiha, K.H. , Broder, M.I. , et al.: Right ventricular infarction. Clinical and hemodynamic features . Am. J. Cardiol., 33: 209-214, 1974.

11.

Wells, D.E. , Befeler, B. : Dysfunction of the right ventricle in coronary artery disease. Chest, 66: 230-235, 1974.

12.

Ferlinz, J. , Delivicario, M. , Gorlin, R. : Incidence of right ventricular asynergy in patients with coronary artery disease . Am. J. Cardiol, 38: 557-563, 1976.

13.

Taylor, R.R. , Covell, J.W. , Sonnenblick, E.H. , et al.: Dependence of ventricular distensibility filling of the opposite ventricle. Am. J. Physiol., 213: 711-718, 1967.

14.

Laks, M.M. , Garner, D. , Swan, H.J.C. : Volumes and compliances measured simultaneously in the right and left ventricles of the dog. Circ., Res., 20: 565-569, 1967.

15.

Kelly, D.T. , Spotnitz, H.M. , Beiser, G.D. , et al.: Effects of chronic right ventricular volume and pressure loading on left ventricular performance. Circulation, 64: 403-412, 1971.

16.

Oboler, A.A. , Keefe, J.F. , Gaasch, W.H. , et al.: Influence of left ventricular isovolumic pressure upon right ventricular pressure transients. Cardiology , 58: 32-44, 1973.

17.

Cohn, J.N. , Tristani, F.E. , Khatri, I.M. : Studies in clinical shock and hypotension. J. CLin, Invest. , 48: 2008-2018, 1969.

18.

Forrester, J.S. , Diamond, G. , McHugh, T.J. , et al.: Filling pressures in the right and left sides of the heart in acute myocardial infarction. A reappraisal of central-venous-pressure monitoring. N. Engl. J. Med., 4: 190-192, 1971.

19.

Brundage, B.H. , Cheitlin, M.D. : Left ventricular angiography as a function test. Chest, 64: 70-74, 1973.

20.

Hamby, R.I. , Aintablian, A. , Wisoff, B.G. , et al: Effects of contrast medium on left ventricular pressure and volume with emphasis on coronary artery disease. Am. Heart. J., 93: 9-18, 1977.