Elevated Pulmonary Artery Pressure: Discussion (Part 3)
Several important caveats apply, however. First, pulmonary pressure during routine cardiac catheterization is a crude physiologic measure of LV compliance. A number of conditions, including, among others, the geometry of the left ventricle,- loading conditions, and myocardial ischemia, influence diastolic function and make it difficult to obtain accurate estimates of compliance. Second, increases in pulmonary pressures are also an important consequence of loss of LV systolic function, as demonstrated in our data by the significant correlation between LVEF and mean pulmonary pressure (r= —0.32, p<0.001). It is also possible that increases in mean pulmonary artery pressure (MPAP) reflect primarily the presence of pulmonary disease. antibiotic levaquin
The presence of LVH has long been recognized to predict future cardiac events. Recent data with echocardiographic measurements have now supplemented the ECG studies.— Since hypertension is a potent risk factor for CAD, and the presence of CAD alone is associated with an increase in LV size,- significant confounding of the CAD-LVH risk relationship must exist. In support of this contention is the recent Framingham analysis that demonstrates that the standard coronary risk factors, namely hypercholesterolemia and cigarette smoking, are predictive of the presence of LVH. Any analysis that attempts to quantify the risk associated with LVH must therefore control for coexisting CAD. With coronary arteriography on all participants, our data provide the first direct examination of this question, and confirm the interaction between CAD and LVH.