Elevated Pulmonary Artery Pressure (Part 1)
The prognostic value of hemodynamic studies of the pulmonary circulation has been recognized for a number of years in patients with mitral valve dysfunction and chronic lung disease. Little information is available, however, on the relationship between abnormalities in pulmonary hemodynamics and prognosis in patients with coronary artery disease (CAD), and virtually no data exist (to our knowledge) on the prognostic importance of pulmonary hypertension in individuals with normal coronary arteries and normal systolic function. The presence of systemic hypertension is well known to increase the risk of cardiac death among patients with and without obstructive CAD, and much of this increased risk has been ascribed to left ventricular hypertrophy (LVH). antibiotic levaquin
The mechanism of this increased mortality risk remains unknown, however. Although decreased left ventricular (LV) compliance, as demonstrated by reduced diastolic filling rates, left atrial enlargement, and direct measurement of pressure-volume relationships, has been demonstrated in hypertension with associated LVH, the prognostic significance of these findings has never been evaluated. Control for the impact of left-sided cardiac failure due to loss of systolic function is obviously necessary to evaluate the potential independent predictive importance of decreased compliance. Left ventricular hypertrophy itself can result in heart failure with normal LV systolic function,’ and the relative contribution of increased myocardial thickness to loss of compliance must likewise be considered.