Assessing risk by hemodynamic profile in patients awaiting cardiac transplantation

Morley, Deborah; Brozena, Susan C.

doi:10.1016/0002-9149(94)90012-4

Cited by 73 publications

(46 citation statements)

References 15 publications

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“…For example, previous studies with an implantable monitor showed an increase of 16Ϯ6 mm Hg, or a 71% increase, from baseline in ePAD during a 6-minute walk in 21 patients, although the highest pressures occurred briefly during activity other than during formal exercise. 3,8 These components of daily life integrate into the filling pressures measured during the entire 24-hour period, for which optimal levels have not previously been described.…”

Section: Discussionmentioning

confidence: 99%

Chronic Ambulatory Intracardiac Pressures and Future Heart Failure Events

Stevenson

Zile

Bennett

et al. 2010

Circ: Heart Failure

129

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Background-Intracardiac pressures in heart failure (HF) have been measured in patients while supine in the hospital but change at home with posture and activity. The optimal level of chronic ambulatory pressure is unknown. This analysis compared chronic intracardiac pressures to later HF events and sought a threshold above which higher pressures conferred worse outcomes. Methods and Results-Median pressures were measured every 24 hours from continuous 8-minute segments for 6 months after implantation of hemodynamic monitors in 261 patients with New York Heart Association class III-IV HF in the Chronicle Offers Management to Patients with Advanced Signs and Symptoms of Heart Failure Study. Baseline and chronic daily medians of estimated pulmonary artery diastolic, right ventricular systolic, and right ventricular end-diastolic pressures were compared with HF event rate. The group median for chronic 24-hour estimated pulmonary artery diastolic pressure was 28 mm Hg (excluding 7 days before and after events). Despite weight-guided management, events occurred in 100 of 261 (38%) patients. Event risk increased progressively with higher chronic 24-hour estimated pulmonary artery diastolic pressure, from 20% at 18 mm Hg to 34% at 25 mm Hg and 56% at 30 mm Hg, with similar relations for right ventricular pressures. Among patients with baseline day median estimated pulmonary artery diastolic pressures of Ն25 mm Hg, event risk was 1.10/6 mo when they remained chronically Ն25 mm Hg, but risk fell to 0.47 when 24-hour pressures declined to Ͻ25 mm Hg for more than half of the days. Conclusions-Despite current management, many patients with advanced HF live on a plateau of high filling pressures from which later events occur. This risk is progressively higher with higher chronic ambulatory pressures. It is not known whether more targeted intervention could maintain lower chronic ambulatory pressures and better outcomes. (Circ Heart Fail. 2010;3:580-587.)

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Section: Discussionmentioning

confidence: 99%

Chronic Ambulatory Intracardiac Pressures and Future Heart Failure Events

Stevenson

Zile

Bennett

et al. 2010

Circ: Heart Failure

129

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“…[22][23][24][25][26] Whereas the patients with PH-HFpEF in our study had a lower mPAP and PVR compared with patients with PAH, they had higher mRAP, a well-known predictor of mortality in PAH and left-heart failure. 27,28 The mechanism behind this finding is unclear. It may reflect worse right-heart function, neurohormonal activation, worse renal function, or increased intravascular volume.…”

Section: Pah Versus Ph-hfpefmentioning

confidence: 99%

Clinical Characteristics of Pulmonary Hypertension in Patients With Heart Failure and Preserved Ejection Fraction

Thenappan

Shah

Gomberg‐Maitland

et al. 2011

Circ: Heart Failure

267

178

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Background-Pulmonary vascular disease associated with left-side heart failure and preserved ejection fraction (PH-HFpEF) is an increasingly common cause of pulmonary hypertension. The distinction between PH-HFpEF and pulmonary arterial hypertension (PAH) is important because therapies indicated for PAH can be detrimental in HFpEF. Old age, the presence of hypertension and coronary artery disease, the absence of right atrial enlargement, higher aortic systolic pressure, higher mean right atrial pressure, and higher cardiac output best differentiated PH-HFpEF from PAH (area under the receiver operating characteristics curve; curve 0.97). Compared with HFpEF patients without pulmonary hypertension, PH-HFpEF patients were often female and more symptomatic, more often had right ventricular hypertrophy and right atrial enlargement, and had higher right atrial pressure. Conclusions-These data should help better identify PH-HFpEF, an entity that has become increasingly recognized and difficult to treat. (Circ Heart Fail. 2011;4:257-265.)

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“…In a previous study, patients with a right atrial pressure >12 mmHg had a 47% 1-year survival rate compared with the 68% survival rate for those with a right atrial pressure <12 mmHg. 21 Elevated right atrial pressure resulting from right ventricular failure was also associated with a significantly increased risk of early death after heart transplantation. 22 In addition, liver insufficiency with prolonged prothrombin time or elevated serum levels of liver enzymes before transplantation was an independent predictor of early death after heart transplantation.…”

Section: Ascitesmentioning

confidence: 99%

Heart Transplantation in Patients With End-Stage Heart Failure and Cardiac Ascites

Hsu

2007

Circ J

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Background Clinical outcome of heart transplantation in patients with heart failure and ascites has not been reported. Here, the clinical outcome of heart transplantation in patients with heart failure and ascites is evaluated. Between 1989 and 2005, 45 patients with heart failure and ascites underwent an orthotopic heart transplantation. Of the 45 patients, 33 were men (median age 44 years, range 10-63 years). Causes of heart failure included congenital heart disease in 4 patients (9%), dilated cardiomyopathy in 21 patients (47%), rheumatic heart disease in 7 patients (16%), coronary artery disease in 10 patients (22%), and others. Twenty of the 45 patients (44%) had undergone a previous cardiac operation. Hospital mortality occurred in 10 patients (22%) because of bleeding in 4, sepsis with multiple organ failure in 5 and non-diagnostic graft failure in 1 patient. Re-operation for postoperative bleeding occurred in 14 patients (31%). Independent risk factors for hospital death were low serum albumin (odds ratio 0.05; 95% confidence interval 0.003-0.591; p=0.018) and re-operation for bleeding (odds ratio 30.11; 95% confidence interval 2.38-380.26; p=0.009). Conclusions Heart transplantation in patients with heart failure and ascites was associated with high hospital mortality and morbidity. The co-existence of ascites and hypoalbuminemia implied poor prognosis. (Circ J 2007; 71: 1744 -1748 Methods and Results

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Assessing risk by hemodynamic profile in patients awaiting cardiac transplantation

Cited by 73 publications

References 15 publications

Chronic Ambulatory Intracardiac Pressures and Future Heart Failure Events

Chronic Ambulatory Intracardiac Pressures and Future Heart Failure Events

Clinical Characteristics of Pulmonary Hypertension in Patients With Heart Failure and Preserved Ejection Fraction

Heart Transplantation in Patients With End-Stage Heart Failure and Cardiac Ascites

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