Right-Heart Catheterization in Coronary Artery Disease

Friedman, Howard S.
December 1978
Angiology;Dec1978, Vol. 29 Issue 12, p878
Academic Journal
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% stenosis) 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/m�, P < 0.001) than group H 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/m�, 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/m� LVEDP: 33 � 2 mm Hg; SW: 28 � 5.5 gm-m/m� 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.


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