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(Circulation. 1973;47:317.)
© 1973 American Heart Association, Inc.

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Relationship between Pulmonary Artery End-Diastolic Pressure and Left Ventricular Filling Pressure in Patients in Shock

MELVIN SCHEINMAN M.D.¹; G. THOMAS EVANS M.D.¹; ALAN WEISS M.D.¹; ELLIOT RAPAPORT M.D.¹

¹ From the Cardiopulmonary Laboratory and Medical Services, San Francisco General Hospital, and the Department of Medicine and the Cardiovascular Research Institute, University of California, San Francisco.

Bedside catheterization permitted 56 simultaneous measurements of left ventricular end-diastolic pressure (LVEDP) and pulmonary artery end-diastolic pressure (PAEDP) in 25 patients in shock. Measurements were made over a wide range of heart rates (60-160 beats/min), arterial oxygen tension (P_oo2; 33-562 mm Hg), stroke volumes (9-105 ml), and systolic arterial pressures (65-250 mm Hg), and before and during various therapeutic interventions. There was good correlation between PAEDP and LVEDP (r = +0.85) and PAEDP and left ventricular pre-a pressure (r = +0.82). In 16 patients breathing room air, mean arterial P_oo2 was 58 ± 15 mm Hg and rose significantly to 282 ± 16 mm Hg after breathing oxygen (P<0.01), but there was no significant change in the correlation between PAEDP and LVEDP before (r = +0.80) or during oxygen breathing (r = +0.80). Similarly, in seven patients treated with inotropic agents there was excellent correlation between PAEDP and LVEDP before (r = +0.96) and during inotropic therapy (r = +0.86). A PAEDP in excess of 15 mm Hg nearly always reflected increased LVEDP while a PAEDP less than 10 mm Hg was always associated with normal LVEDP. Thus in our patients with shock PAEDP represented a good estimate of LVEDP during a variety of therapeutic interventions and therefore represents a useful tool in guiding the therapy of patients in shock.

Key Words: Pulmonary artery pressures • Hypoxia • Inotropic agents • Myocardial infarction • Shock • Left ventricular pressures

Submitted on June 26, 1972
Accepted on October 12, 1972

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