Mismatch of Right- and Left-Sided Filling Pressures in Chronic Heart Failure

Campbell, Patricia; Drazner, Mark H.; Kato, Masashi; Lakdawala, Neal K.; Palardy, Maryse; Nohria, Anju; Stevenson, Lynne Warner

doi:10.1016/j.cardfail.2011.02.013

Cited by 72 publications

(41 citation statements)

References 29 publications

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“…4,5 In a cohort of patients with advanced heart failure undergoing cardiac transplant evaluation, female sex was the only characteristic found to be associated with the RAP to PCWP relationship, as assessed by 4 categories based on whether the RAP was ≥10 mm Hg and PCWP ≥22 mm Hg. 5 In the present study, female sex was not associated with RAP/PCWP ratio. Also in contrast to the present study, renal dysfunction, PVR, cardiac index, and echocardiographic assessment of RV dysfunction were not significantly different among the 4 hemodynamic profiles in the prior study.…”

Section: Discussionmentioning

confidence: 99%

“…Also in contrast to the present study, renal dysfunction, PVR, cardiac index, and echocardiographic assessment of RV dysfunction were not significantly different among the 4 hemodynamic profiles in the prior study. 5 We postulate that this difference is in part based on the analytic approach used; ie, a hemodynamic classification based on dichotomous values of RAP and PCWP or via the RAP/ PCWP ratio. Nevertheless, both studies demonstrated significant variability in the relationship of right-and left-sided ventricular filling pressures in patients with advanced heart failure.…”

Section: Discussionmentioning

confidence: 99%

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Relationship of Right- to Left-Sided Ventricular Filling Pressures in Advanced Heart Failure

Drazner

Velez-Martinez

Ayers

et al. 2013

Circ: Heart Failure

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106

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Background— Although right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) are correlated in heart failure, in a sizeable minority of patients, the RAP and PCWP are not tightly coupled. The basis of this variability in the RAP/PCWP ratio, and whether it conveys prognostic value, is not known. Methods and Results— We analyzed the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial database. Baseline characteristics, including echocardiographic assessment of right ventricular (RV) structure and function, and invasively measured hemodynamic parameters, were compared among tertiles of the RAP/PCWP ratio. Multivariable Cox proportional hazard models assessed the association of RAP/PCWP ratio with the primary ESCAPE outcome (6-month death or hospitalization [days]) adjusting for systolic blood pressure, blood urea nitrogen, 6-minute walk distance, and PCWP. The RAP/PCWP tertiles were 0.27 to 0.4 (tertile 1); 0.41 to 0.615 (tertile 2), and 0.62 to 1.21 (tertile 3). Increasing RAP/PCWP was associated with increasing median right atrial area (23, 26, 29 cm 2 , respectively; P <0.005), RV area in diastole (21, 27, 27 cm 2 , respectively; P <0.005), and pulmonary vascular resistance (2.4, 2.9, 3.6 woods units, respectively; P =0.003), and lower RV stroke work index (8.6, 8.4, 5.5 g·m/m 2 per beat, respectively; P <0.001). RAP/PCWP ratio was associated with death or hospitalization within 6 months (hazard ratio, 1.16 [1, 1.4]; P <0.05). Conclusions— Increased RAP/PCWP ratio was associated with higher pulmonary vascular resistance, reduced RV function (manifest as a larger right atrium and ventricle and lower RV stroke work index), and an increased risk of adverse outcomes in patients with advanced heart failure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Relationship of Right- to Left-Sided Ventricular Filling Pressures in Advanced Heart Failure

Drazner

Velez-Martinez

Ayers

et al. 2013

Circ: Heart Failure

Self Cite

106

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“…We believe this is a consequence of tachycardia and atrial arrhythmia themselves reducing the TAPSE values not only in TIC but also in DCM patients, 29,30 supporting that CMR-assessed RV function may be valuable compared with echocardiography. Furthermore, considering the ventricular interaction and pressure "mismatch" known between the left-and right-sided pressures, 31 contrasting RV variables with LV variables, such as the RVEF/LVEF and RVEDV/ LVEDV in our study, may be useful for assessing RV function, as reported in animal studies. 32 Our study also found younger age as a predictor of TIC.…”

Section: Discussionmentioning

confidence: 98%

Diagnostic Value of Right Ventricular Dysfunction in Tachycardia-Induced Cardiomyopathy Using Cardiac Magnetic Resonance Imaging

Okada

Nakajima

Morita

et al. 2016

Circ J

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Background: Predicting tachycardia-induced cardiomyopathy (TIC) in patients presenting with left ventricular (LV) dysfunction and tachyarrhythmias remains challenging. We assessed the diagnostic value of early right ventricular (RV) dysfunction to predict TIC using cardiac magnetic resonance (CMR) imaging. Methods and Results:A total of 102 consecutive patients with newly diagnosed LV dysfunction and atrial tachyarrhythmias were examined. Patients whose LV ejection fraction (EF) improved to ≥50% during a 1-year follow-up were diagnosed with TIC, and with dilated cardiomyopathy (DCM) in those whose did not improve. CMR was performed at a median of 23 days after admission, and the TIC and DCM patients exhibited different distributions of EF and end-diastolic volume (EDV) between the LV and RV (both P<0.001, ANCOVA). TIC patients had significantly lower RVEF/LVEF ratio (1.01±0.23 vs. 1.36±0.31, P<0.001) and higher RVEDV/LVEDV ratio (0.96±0.21 vs. 0.73±0.19, P<0.001) compared with DCM patients, suggesting that RV systolic dysfunction and RV dilatation were observed in TIC. In the multivariate analysis, age, RVEF/LVEF ratio, and RVEDV/LVEDV ratio were significant predictors of TIC, and RVEF/LVEF ratio of <1.05 most highly predicted TIC with a sensitivity of 69.1% and specificity of 91.5% (area under the curve 0.860). Conclusions:Among patients with newly diagnosed LV dysfunction and atrial tachyarrhythmias, age and coexistence of RV dysfunction was a strong predictor of TIC. (Circ J 2016; 80: 2141 -2148

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“…However, the mandatory LVEF in this study was ≤30%, and in 25% to 30% of HF patients, right atrial pressure and PCWP are not tightly coupled. 41 Notably, neither of these studies perturbed the cardiovascular system (eg, volume loading) and then repeated measurement of hemodynamics to correlate with subsequent adverse events.…”

Section: Denardo Et Al Contrast Media and Adverse Event Predictionmentioning

confidence: 99%

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

Denardo

Vock

Schmalfuss

et al. 2016

Circ: Heart Failure

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Background— Contrast media administered during cardiac catheterization can affect hemodynamic variables. However, little is documented about the effects of contrast on hemodynamics in heart failure patients or the prognostic value of baseline and changes in hemodynamics for predicting subsequent adverse events. Methods and Results— In this prospective study of 150 heart failure patients, we measured hemodynamics at baseline and after administration of iodixanol or iopamidol contrast. One-year Kaplan–Meier estimates of adverse event–free survival (death, heart failure hospitalization, and rehospitalization) were generated, grouping patients by baseline measures of pulmonary capillary wedge pressure (PCWP) and cardiac index (CI), and by changes in those measures after contrast administration. We used Cox proportional hazards modeling to assess sequentially adding baseline PCWP and change in CI to 5 validated risk models (Seattle Heart Failure Score, ESCAPE [Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness], CHARM [Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity], CORONA [Controlled Rosuvastatin Multinational Trial in Heart Failure], and MAGGIC [Meta-Analysis Global Group in Chronic Heart Failure]). Median contrast volume was 109 mL. Both contrast media caused similarly small but statistically significant changes in most hemodynamic variables. There were 39 adverse events (26.0%). Adverse event rates increased using the composite metric of baseline PCWP and change in CI ( P <0.01); elevated baseline PCWP and decreased CI after contrast correlated with the poorest prognosis. Adding both baseline PCWP and change in CI to the 5 risk models universally improved their predictive value ( P ≤0.02). Conclusions— In heart failure patients, the administration of contrast causes small but significant changes in hemodynamics. Calculating baseline PCWP with change in CI after contrast predicts adverse events and increases the predictive value of existing models. Patients with elevated baseline PCWP and decreased CI after contrast merit greatest concern.

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Mismatch of Right- and Left-Sided Filling Pressures in Chronic Heart Failure

Cited by 72 publications

References 29 publications

Relationship of Right- to Left-Sided Ventricular Filling Pressures in Advanced Heart Failure

Relationship of Right- to Left-Sided Ventricular Filling Pressures in Advanced Heart Failure

Diagnostic Value of Right Ventricular Dysfunction in Tachycardia-Induced Cardiomyopathy Using Cardiac Magnetic Resonance Imaging

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

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