Baseline Hemodynamics and Response to Contrast Media During Diagnostic Cardiac Catheterization Predict Adverse Events in Heart Failure Patients

Denardo, Scott J.; Vock, David M.; Schmalfuss, Carsten; Young, Gregory; Tcheng, James E.; O’Connor, Christopher M.

doi:10.1161/circheartfailure.115.002529

Cited by 7 publications

(17 citation statements)

References 40 publications

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“…The patient number was smaller than 200 in 11 out of 20 studies, of which the smallest population comprised 93 HF-patients [20]. In six out of 20 studies, the number of events was low (<50) [19,20,24,25,28,38], and in three out of 20 studies, the ratio of events per number of studied variables was adequate [26,31,36,39]. The outcome measurement was checked externally in only four studies [19,31,34,36].…”

Section: Resultsmentioning

confidence: 99%

“…In nine out of 20 studies, CI or CO was a significant predictor of the outcome in UV analysis [21,22,25,26,27,28,30,33,37]. PCWP was a significant UV-predictor of the outcome in 19 out of 20 studies [19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,36,37,38]. Of the 15 studies in which SBP was evaluated in UV analysis, 10 studies demonstrated SBP as a significant predictor [21,22,23,27,28,31,32,34,36,37].…”

Section: Resultsmentioning

confidence: 99%

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Comparison of Hemodynamic Factors Predicting Prognosis in Heart Failure: A Systematic Review

Aalders¹,

Kok²

2019

JCM

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Objectives: We systematically reviewed the literature to address the question of which of the three hemodynamic factors predicts prognosis best in heart failure patients when directly compared to each other: cardiac output, preload or afterload. Methods: Prognostic studies in heart failure (HF) were searched that included at least two of the three hemodynamic variables: (1) cardiac output or cardiac index (CI), (2) preload represented by pulmonary capillary wedge pressure (PCWP) and (3) afterload simplified to systolic blood pressure (SBP). Critical appraisal was done according to the QUIPS format for prognostic studies. The main endpoint was all-cause mortality, which could be combined with other endpoints. We report the number of studies in which CI, PCWP and SBP remained significant prognostic predictors in multivariate analysis. We also assessed whether hemodynamic predictors of prognosis varied in four different HF-populations. Results: Included were 18 studies containing a multivariate analysis. PCWP was an independent predictor of prognosis in 10 of 18 studies, SBP in 3 of 14 studies and CI in none of 18 studies. Results were not specific for any of the HF-populations. Conclusions: A higher PCWP and lower SBP are independent predictors of poor prognosis in HF. In spite of the frequently used concept behind HF, this review demonstrates that CI is not an independent predictor of prognosis in HF.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Comparison of Hemodynamic Factors Predicting Prognosis in Heart Failure: A Systematic Review

Aalders¹,

Kok²

2019

JCM

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“…There has been a renewed interest in the importance of invasive hemodynamics measurement during the past decade. Denardo et al 21 reported in a subanalysis of the ESCAPE trial (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) that patients with lower PCWP and higher CI had improved survival. Shah et al 6 recently demonstrated that functional capacity, which was assessed by 6-minute walk distance, improved when patients' hemodynamics were normalized by invasive hemodynamic ramp tests.…”

Section: Hemodynamic Optimization and Reduced Readmissionmentioning

confidence: 99%

Optimal Hemodynamics During Left Ventricular Assist Device Support Are Associated With Reduced Readmission Rates

Imamura

Jeevanandam

Kim

et al. 2019

Circ: Heart Failure

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BACKGROUND: Left ventricular assist device (LVAD) therapy improves the hemodynamics of advanced heart failure patients. However, it is unknown whether hemodynamic optimization improves clinical outcomes. The aim of this study was to investigate whether hemodynamic optimization reduces hospital readmission rate in LVAD patients. METHODS AND RESULTS: LVAD patients undergoing an invasive hemodynamic ramp test were prospectively enrolled and followed for 1 year. LVAD speed was optimized using a ramp test, targeting the following goals: central venous pressure <12 mm Hg, pulmonary capillary wedge pressure <18 mm Hg, and cardiac index >2.2 L/(min•m 2). The frequency and cause of hospital readmissions were compared between patients who achieved (optimized group) or did not achieve (nonoptimized group) these goals. Eighty-eight outpatients (median 61 years old, 53 male) underwent ramp testing 236 days after LVAD implantation, and 54 (61%) had optimized hemodynamics after LVAD speed adjustment. One-year survival after the ramp study was comparable in both groups (89% versus 88%). The total hospital readmission rate was lower in the optimized group compared with the nonoptimized group (1.15 versus 2.86 events/y, P<0.001). This result was predominantly because of a reduction in the heart failure readmission rate in the optimized group (0.08 versus 0.71 events/y, P=0.016). CONCLUSIONS: LVAD patients, in whom hemodynamics were optimized, had a significantly lower rate of hospital readmissions, primarily because of fewer heart failure admissions. These findings highlight the importance of achieving hemodynamic optimization in LVAD patients.

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“…There has been a renewed interest in the importance of hemodynamic optimization in HF patients during the last decade. Denardo et al 24 reported in a subanalysis of the ESCAPE trial that HF patients with lower PCWP and higher CI had improved survival. The dramatic reduction in HF readmission in patients implanted with an implantable PAP monitor emphasizes the importance of hemodynamic management.…”

Section: Clinical Implication Of Concomitant Mitral Valve Surgerymentioning

confidence: 99%

Hemodynamic Effects of Concomitant Mitral Valve Surgery and Left Ventricular Assist Device Implantation

et al. 2020

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There are conflicting data regarding whether concomitant mitral valve surgery (MVS) at left ventricular assist device (LVAD) implantation is beneficial. This study aimed to assess the hemodynamic effects of concomitant MVS. Of all 73 enrolled patients, 44 patients had undergone concomitant MVS and 29 patients had not. Before LVAD implantation, MVS group had higher pulmonary capillary wedge pressure (p = 0.04). After LVAD implantation, MVS group had higher mean pulmonary artery pressure and cardiac output (CO). During the hemodynamic ramp study, MVS group had steeper CO slopes (0.18 [0.13 0.28] vs. 0.15 [0.08, 0.20] L/min/step; p = 0.04) at incremental LVAD speed and achieved a higher CO at the optimized set speed (5.5 [4.7, 6.9] vs. 4.9 [4.0, 5.7] L/min; p = 0.03). One-year freedom from death or heart failure readmission was statistically comparable between the two groups (61% vs. 80%, p = 0.20). Thus far, after LVAD implantation and concomitant MVS, patients had increased pulmonary hypertension, despite having higher CO and a better response of CO at incremental LVAD speed. The implication of hemodynamic features after concomitant MVS on clinical outcomes warrants further investigation.

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Baseline Hemodynamics and Response to Contrast Media During Diagnostic Cardiac Catheterization Predict Adverse Events in Heart Failure Patients

Cited by 7 publications

References 40 publications

Comparison of Hemodynamic Factors Predicting Prognosis in Heart Failure: A Systematic Review

Comparison of Hemodynamic Factors Predicting Prognosis in Heart Failure: A Systematic Review

Optimal Hemodynamics During Left Ventricular Assist Device Support Are Associated With Reduced Readmission Rates

Hemodynamic Effects of Concomitant Mitral Valve Surgery and Left Ventricular Assist Device Implantation

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