Objective: To report the hemodynamic and functional responses obtained with clinical optimization guided by hemodynamic parameters in patients with severe and refractory heart failure.
Methods: Invasive hemodynamic monitoring using right heart catheterization aimed to reach low filling pressures and peripheral resistance. Frequent adjustments of intravenous diuretics and vasodilators were performed according to the hemodynamic measurements.
Results: We assessed 19 patients (age = 48+/-12 years and ejection fraction = 21+/-5%) with severe heart failure. The intravenous use of diuretics and vasodilators reduced by 12 mm Hg (relative reduction of 43%) pulmonary artery occlusion pressure (P<0.001), with a concomitant increment of 6 mL per beat in stroke volume (relative increment of 24%, P<0.001). We observed significant associations between pulmonary artery occlusion pressure and mean pulmonary artery pressure (r=0.76; P<0.001) and central venous pressure (r=0.63; P<0.001). After clinical optimization, improvement in functional class occurred (P< 0.001), with a tendency towards improvement in ejection fraction and no impairment to renal function.
Conclusion: Optimization guided by hemodynamic parameters in patients with refractory heart failure provides a significant improvement in the hemodynamic profile with concomitant improvement in functional class. This study emphasizes that adjustments in blood volume result in immediate benefits for patients with severe heart failure.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1590/s0066-782x2002000300001 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Delayed occluder displacement following patent ductus arteriosus closure successfully managed with thoracic endovascular aortic repair: a case report and literature review.
J Cardiothorac Surg
January 2025
Department of Cardiovascular Surgery of The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, Zhejiang, 310000, China.
Interventional occlusion of Patent ductus arteriosus (PDA) is generally efficacious and complications such as delayed occluder displacement are infrequent. Herein, we report a case of 24-year-old female with a history of unsuccessful PDA closures, who subsequently experienced delayed occluder displacement into the left main pulmonary artery. Despite numerous unsuccessful catheter-based interventions, thoracic endovascular aortic repair (TEVAR) was successfully executed.
View Article and Find Full Text PDFArtificial intelligence for hemodynamic monitoring with a wearable electrocardiogram monitor.
Commun Med (Lond)
January 2025
Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, USA.
Background: The ability to non-invasively measure left atrial pressure would facilitate the identification of patients at risk of pulmonary congestion and guide proactive heart failure care. Wearable cardiac monitors, which record single-lead electrocardiogram data, provide information that can be leveraged to infer left atrial pressures.
Methods: We developed a deep neural network using single-lead electrocardiogram data to determine when the left atrial pressure is elevated.
Introduction: Lung transplantation (LT) is a lifesaving procedure in patients with end stage lung failure. The prevalence of coronary artery disease (CAD) in patients with lung disease is comparably high, and coronary angiography is widely used for coronary anatomy assessment prior to LT. Detection of significant CAD usually results in revascularization to minimize post-transplant cardiovascular events.
View Article and Find Full Text PDFThe uses of right heart catheterization in cardio-pulmonary disease: State-of-the-art.
Am Heart J Plus
January 2025
Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY, USA.
The right heart catheterization (RHC) remains an important diagnostic tool for a spectrum of cardiovascular disease processes including pulmonary hypertension (PH), shock, valvular heart disease, and unexplained dyspnea. While it gained widespread utilization after its introduction, the role of the RHC has evolved to provide valuable information for the management of advanced therapies in heart failure (HF) and cardiogenic shock (CS) to name a few. In this review, we provide a comprehensive overview on the indications, utilization, complications, interpretation, and calculations associated with RHC.
View Article and Find Full Text PDFCatheterization Techniques for Anomalous Aortic Origin of Coronary Arteries.
Catheter Cardiovasc Interv
January 2025
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France.
Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital anomaly with a large spectrum of anatomical variations. Selective engagement of an AAOCA can present challenges during cardiac catheterization. A comprehensive understanding of the characteristics of major AAOCA can effectively assist operators for selecting and maneuvering catheters.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!