Peripheral venous pressure measurements to evaluate congestion in pulmonary arterial hypertension

Right atrial pressure (RAP) is an important prognostic criterion in pulmonary hypertension. Elevated mean RAP measured by cardiac catheterization is an independent risk factor for mortality. Accurate bedside assessment of congestion in the management of patients with PH remains challenging. As a continuous conduit of circulating fluid, systemic congestion represented by high RAP may be reflected by peripheral venous pressure (PVP). We evaluated the reliability of PVP measurements for assessing congestion beyond conventional clinical assessments.

We performed conventional congestion assessments and PVP measurements in 138 patients undergoing right heart catheterization. PVP was measured via the 16-gauge peripheral venous access placed in the upper extremity.

The mean RAP and PVP were 8.7 ± 4.2 mm Hg and 10.7 ± 4.3 mm Hg, respectively. PVP exhibited a strong linear correlation with RAP (Pearson R = 0.839; P < .001). PVP demonstrated significant discriminatory power for both RAP < 8 mm Hg (area under the curve: 0.91 [95% confidence interval: 0.86 to 0.96]; sensitivity: 72%; specificity: 94% cutoff: 8.5 mm Hg) and RAP ≥ 12 mm Hg (area under the curve: 0.92 [0.87 to 0.97]; sensitivity: 82%; specificity: 89% cutoff: 12.5 mm Hg).

PVP measured via peripheral venous access strongly correlates with invasively obtained RAP. PVP measurements may improve current bedside assessments of congestion.