Interpretation of high wedge pressure on exercise in patients with chronicobstructive pulmonary disease

In a retrospective review of patients subjected to right heart catheterizat ion, case records from 109 consecutive patients with chronic obstructive pu lmonary disease (COPD) and wedge pressure greater than or equal to 15 mm Hg on exercise were analyzed. Patients were separated into group 1, resting w edge pressure (Tw) < 15 mm Hg and difference between Pw and right atrial pr essure (Pra) change on exercise <5 mm Hg (n = 54), group 2, same Pw at rest but increase in Pw on exercise greater than or equal to5 mm Hg, being high er than that of Tra (n = 34), and group 3, Pw greater than or equal to 15 m m Hg at rest (n = 21). The occurrence of left heart disease increased from group 1 to group 3 (19, 53 and 71%, respectively), and the slope of the Pw/ stroke index relationship was lowest in group 3. High Pw on exercise can be explained by the pressure rise in the cardiac fossa associated with lower lobe gas trapping in group 1, which showed the most severe airflow limitati on, decreased left ventricular compliance in group 2, and heart failure in group 3. Copyright (C) 2001 S. Karger AG, Basel.