Postural Changes During Right Heart Catheterization
| Status: | Recruiting |
|---|---|
| Conditions: | High Blood Pressure (Hypertension), High Blood Pressure (Hypertension), Cardiology |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/21/2018 |
| Start Date: | May 1, 2017 |
| End Date: | March 19, 2019 |
| Contact: | Hubert "Jimmy" J Ford, MD |
| Email: | hubert_ford@med.unc.edu |
| Phone: | (919) 966-2531 |
Assessing the Influence of Postural Changes During Right Heart Catheterization for the Evaluation of Pulmonary Hypertension
Hemodynamic measurements obtained during pulmonary artery catheterization are essential for
the diagnosis and classification of pulmonary hypertension. Traditionally, right heart
catheterization (RHC) is done in the supine position. Cardiac output is known to change
significantly based on position, due to the effects of gravity on venous return. There has
not been a systematic investigation into these postural effects on pulmonary arterial
pressures nor their effect on the diagnosis of pulmonary hypertension. It is our intent to
study the differences in measurements obtained during RHC when the patient is supine, seated,
and standing.
the diagnosis and classification of pulmonary hypertension. Traditionally, right heart
catheterization (RHC) is done in the supine position. Cardiac output is known to change
significantly based on position, due to the effects of gravity on venous return. There has
not been a systematic investigation into these postural effects on pulmonary arterial
pressures nor their effect on the diagnosis of pulmonary hypertension. It is our intent to
study the differences in measurements obtained during RHC when the patient is supine, seated,
and standing.
The investigators also plan a prospective study of patients referred for pulmonary artery
catheterization at the UNC cardiac catheterization lab for evaluation of known or suspected
pulmonary hypertension. The purpose of this portion of the study is to evaluate the degree to
which digital reading of pulmonary artery pressure (PAP) and pulmonary capillary wedge
pressure (PCWP) impact the diagnosis and classification of pulmonary hypertension
specifically in patients being evaluated for pulmonary hypertension while being tested in the
supine, sitting and standing positions.
The investigators will identify 60 patients referred for right heart catheterization to
evaluate known or suspected pulmonary hypertension. Patients will have right heart
catheterization performed by the clinician that was planning on performing the procedure and
a pulmonary hypertension specialist in the Division of Pulmonary and Critical Care Medicine
or Division of Cardiology. After informed consent is obtained, the subject will be prepped
and draped per protocol in the UNC Cath lab. Their internal jugular vein will be visualized
by ultrasound and accessed with a pulmonary artery catheter using standard procedure which
also uses fluoroscopy to ensure correct placement of the catheter. Once pressure measurements
are obtained from the cardiac chambers and pulmonary arteries, the catheter will be secured
into place with tegaderm to allow for mobilization of the patient. The patient will then be
asked to sit up on the side of the cath table and the pressure transducer will be
re-calibrated to be at the level of the patient's right atrium. Repeat measurements will be
obtained of the pulmonary artery and PCWP in this position. After, the patient will be asked
to stand up and the pressure transducer once again re-calibrated to estimate the level of the
right atrium; new measurements will be obtained in the standing position. Each position will
be maintained for 5 minutes before measurements are taken. The supine position measurement
will be used for clinical decision making purposes as per usual. The investigators will
collect each measurement over at least 10 cardiac cycles and use the mean end-expiratory
values to ensure precision.
Once all measurements are obtained, the patient will be asked to return to the supine
position. The tegaderm will be released and the catheter removed during sustained expiration
maneuver per standard protocol.
No sedation will be administered to the patients.
No further contact will be done with the study subject for the purpose of this research
trial.
catheterization at the UNC cardiac catheterization lab for evaluation of known or suspected
pulmonary hypertension. The purpose of this portion of the study is to evaluate the degree to
which digital reading of pulmonary artery pressure (PAP) and pulmonary capillary wedge
pressure (PCWP) impact the diagnosis and classification of pulmonary hypertension
specifically in patients being evaluated for pulmonary hypertension while being tested in the
supine, sitting and standing positions.
The investigators will identify 60 patients referred for right heart catheterization to
evaluate known or suspected pulmonary hypertension. Patients will have right heart
catheterization performed by the clinician that was planning on performing the procedure and
a pulmonary hypertension specialist in the Division of Pulmonary and Critical Care Medicine
or Division of Cardiology. After informed consent is obtained, the subject will be prepped
and draped per protocol in the UNC Cath lab. Their internal jugular vein will be visualized
by ultrasound and accessed with a pulmonary artery catheter using standard procedure which
also uses fluoroscopy to ensure correct placement of the catheter. Once pressure measurements
are obtained from the cardiac chambers and pulmonary arteries, the catheter will be secured
into place with tegaderm to allow for mobilization of the patient. The patient will then be
asked to sit up on the side of the cath table and the pressure transducer will be
re-calibrated to be at the level of the patient's right atrium. Repeat measurements will be
obtained of the pulmonary artery and PCWP in this position. After, the patient will be asked
to stand up and the pressure transducer once again re-calibrated to estimate the level of the
right atrium; new measurements will be obtained in the standing position. Each position will
be maintained for 5 minutes before measurements are taken. The supine position measurement
will be used for clinical decision making purposes as per usual. The investigators will
collect each measurement over at least 10 cardiac cycles and use the mean end-expiratory
values to ensure precision.
Once all measurements are obtained, the patient will be asked to return to the supine
position. The tegaderm will be released and the catheter removed during sustained expiration
maneuver per standard protocol.
No sedation will be administered to the patients.
No further contact will be done with the study subject for the purpose of this research
trial.
Inclusion Criteria:
- All patients that are 18 years or older regardless of gender or race,
- are referred for RHC for evaluation of possible Pulmonary Arterial Hypertension (PAH)
- provide informed consent
Exclusion Criteria:
- Inability to obtain pulmonary artery pressure or PCWP
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