Estimation of pulmonary artery wedge pressure from chest radiograph in patients with chronic congestive cardiomyopathy and ischaemic cardiomyopathy

Dash, H.; Lipton, M.J.; Chatterjee, K.; Parmley, W.W.

British Heart Journal 44(3): 322-329


ISSN/ISBN: 0007-0769
PMID: 6448610
Accession: 005388151

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To define the relation between chest X-ray findings and the level of pulmonary artery wedge pressure in patients with chronic congestive cardiomyopathy, 82 patients had chest radiographs before undergoing 92 hemodynamic studies. The studies were divided into 3 groups according to the level of pulmonary artery wedge pressure (PAWP) (group 1: < 15 mmHg, group 2: 15-24 mmHg, group 3: .gtoreq. 25 mmHg). Venous distribution, interstitial edema, pleural effusions, left atrial enlargement and right ventricular enlargement each occurred in 10% of group 1 studies. Radiological abnormalities generally distinguished group 1 from group 2, but none except cardiothoracic ratio distinguished group 2 from group 3. Cardiothoracic ratio correlated best with pulmonary artery wedge pressure (r = 0.70). Alveolar edema was uncommon when PAWP .gtoreq. 25 mmHg, occurring in 32% of group 3 studies. Stepwise multiple linear regression analysis showed that cardiothoracic ratio, alveolar edema, interstitial edema and left atrial size contributed independently to the prediction of PAWP. The regression analysis improved the accuracy of the estimation of PAWP from the findings noted on standard chest radiographs.