P1429 B-Type natriuretic peptide prediction of right catheterization parameters in the first year after heart transplant

Abstract Introduction Despite being the gold-standard for hemodynamic assessment, right heart catheterization (RHC) was overcome by plasma B-Type Natriuretic Peptide (BNP) levels in daily clinical routine. However, in the first year after heart transplantation (HT), the relationship between BNP and adverse hemodynamics have yielded conflicting results. Purpose The aim of this study was to evaluate whether BNP values can be used to estimate adverse hemodynamics in the first year after HT. Methods Prospective study of consecutive RHC performed in the first year after HT (according to the endomyocardial biopsies program). Plasma BNP levels were measured at the same day. The area under the curve (AUC) was analysed to find the BNP values with higher sensitivity and specificity to detect adverse hemodynamics. Results From 2017 to 2018, 50 RHC were performed. Mean age was 48.7 ± 8.3 years, with mean BNP value of 964.4 ± 1114.7pg/ml. Prediction of adverse hemodynamics by AUC results are represented in the table. BNP values were significantly increased in patients with pulmonary capillary wedge pressure (PCWP) >12mmHg (p < 0.001), cardiac index <2.5L/min/m2 (p = 0.001), mean pulmonary artery pressure (mPAP) ≥25mmHg (p < 0.001), pulmonary vascular resistance > 1,5WU (p = 0.044) and right atrial pressure >5mmHg (p = 0.003). BNP >500pg/ml had a sensitivity of 78.3% and 87.5% and a specificity of 76.0% and 67.7% to detect PCWP >12mmHg and mPAP ≥25mmHg, respectively. Conclusion Significant associations were found between BNP values and adverse hemodynamics in RHC, supporting the clinical utility of BNP in the first year after HT. BNP prediction AUC values SR HEMODYNAMIC PARAMETERS AUC p 95% CI Best BNP value Sensitivity Specificity Pulmonary capillary wedge pressure (PCWP) > 12mmHg 0.798 <0.001 0.671-0.925 > 500pg/ml 78.3% 76.0% Mean pulmonary artery pressure (mPAP) ≥ 25mmHg 0.830 <0.001 0.714-0.946 > 500pg/ml 87.5% 67.7% Cardiac output < 4L/min 0.833 0.002 0.667-1.000 > 1500pg/ml 77.8% 87.5% Cardiac index (CI) < 2.5L/min/m2 0.810 0.001 0.663-0.957 > 1150pg/ml 76.9% 86.1% Pulmonary vascular resistance (PVR) > 1,5WU 0.678 0.044 0.509-0.848 > 200pg/ml 83.3% 47.1% Right atrial pressure (RAP) > 5mmHg 0.744 0.003 0.607-0.880 > 500pg/ml 70.8% 65.4% BNP prediction

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The importance of hemodynamic monitoring in mitrocuspid surgery

Medicinski pregled ◽

10.2298/mpns0602063d ◽

2006 ◽

Vol 59 (1-2) ◽

pp. 63-66

Author(s):

Biljana Dobric ◽

Jasna Petrovic ◽

Ninoslav Radovanovic

Keyword(s):

Cardiac Index ◽

Pulmonary Artery ◽

Pulmonary Capillary Wedge Pressure ◽

Pulmonary Vascular Resistance ◽

Hemodynamic Monitoring ◽

Resistance Index ◽

Hemodynamic Parameters ◽

Pulmonary Capillary ◽

Pulmonary Vascular Resistance Index ◽

Wedge Pressure

Introduction. Untreated mitral valve disease is associated with marked hemodynamic disorders, low ejection fraction (EF) and poor perfusion. The study aimed to explore the importance of hemodynamic monitoring in intraoperative evaluation and treatment of these patients. Material and methods. This prospective study included 85 patients: group I: 41 patients, EF<40%; group II: 44 patients, EF>40%. Hemodynamic parameters were recorded after initation of anesthesia (1), after sternotomy (2), after extracorporeal circulation (ECC) (3) and before leaving the operation theatre (4). The following parameters were assessed: mean arterial pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance index, central venous pressure, cardiac index. Statistical analysis was performed using Student t-test and correlation analyses in time series. Results and Discussion. Hemodynamic parameters were changed at the beginning of surgery, but gradually improved after sternotomy and were normal at the end of the operation. Both examined groups presented with reduction of the pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance index (reduction more than 30%) and cardiac index (up to 100%). Strong correlation between 1/2 and 3/4 assessments pointed to the importance of intraoperative evaluation. Swan-Ganz catheter ia a valuable tool used for hemodynamic monitoring. Conclusion. Intraoperative medication (based on obtained hemodynamic parameters) and operative treatment led to normalization of all parameters in both groups, regardless of the preoperative values of EF. .

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Faculty Opinions recommendation of Prognostic value of the pre-transplant diastolic pulmonary artery pressure-to-pulmonary capillary wedge pressure gradient in cardiac transplant recipients with pulmonary hypertension.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718417343.793502538 ◽

2014 ◽

Author(s):

Jean-Luc Vachiery

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Pressure Gradient ◽

Pulmonary Capillary Wedge Pressure ◽

Pulmonary Artery Pressure ◽

Prognostic Value ◽

Cardiac Transplant ◽

Transplant Recipients ◽

Pulmonary Capillary ◽

Wedge Pressure

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Reliability of measurements of pulmonary artery pressure obtained with patients in the 60 degrees lateral position

American Journal of Critical Care ◽

10.4037/ajcc2000.9.1.43 ◽

2000 ◽

Vol 9 (1) ◽

pp. 43-51 ◽

Cited By ~ 5

Author(s):

LM Aitken

Keyword(s):

Pulmonary Artery ◽

Pulmonary Capillary Wedge Pressure ◽

Pulmonary Artery Pressure ◽

General Medicine ◽

Lateral Position ◽

Artery Pressure ◽

Pulmonary Capillary ◽

Quasi Experimental ◽

The Right ◽

Wedge Pressure

BACKGROUND: Monitoring of pulmonary artery pressure is an essential component of the care of critically ill patients. The conditions under which reliable measurements can be obtained must be clarified. OBJECTIVES: To determine (1) whether reliable measurements of pulmonary artery pressure can be obtained with patients in the right or left 60 degrees lateral position and (2) which characteristics of patients preclude obtaining reliable measurements. METHODS: One hundred five patients (65 cardiac surgery, 40 general medicine) with pulmonary artery catheters were enrolled in a prospective, stratified, quasi-experimental study. Subjects were repositioned from supine (head of bed elevated < 30 degrees with 1 pillow) to the left and right 60 degrees lateral positions. Systolic, diastolic, and mean pulmonary artery pressures and pulmonary capillary wedge pressure were measured before and 5, 10, and 20 minutes after lateral repositioning. The zero reference was the phlebostatic axis when patients were supine and the dependent midclavicular line at the level of the fourth intercostal space when patients were in the lateral positions. RESULTS: In most patients, measurements obtained with patients in the lateral position differed significantly from measurements obtained with patients supine. None of the variables examined were reliable predictors of which patients would have these differences. More than 11% of the patients had clinically significant differences in addition to the statistically significant differences. CONCLUSION: Reliable measurements of pulmonary artery pressure and pulmonary capillary wedge pressure cannot be obtained with patients in the 60 degrees lateral position.

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Activation of myocardial and renal natriuretic peptides during acute intravascular volume overload in dogs: functional cardiorenal responses to receptor antagonism

Clinical Science ◽

10.1042/cs0950195 ◽

1998 ◽

Vol 95 (2) ◽

pp. 195-202 ◽

Cited By ~ 14

Author(s):

Daniel D. BORGESON ◽

Tracy L. STEVENS ◽

Denise M. HEUBLEIN ◽

Yuzuru MATSUDA ◽

John C. BURNETT

Keyword(s):

Pulmonary Capillary Wedge Pressure ◽

Natriuretic Peptide ◽

Natriuretic Peptides ◽

Volume Overload ◽

Treated Group ◽

Atrial Pressure ◽

Right Atrial ◽

Intravascular Volume ◽

Pulmonary Capillary ◽

Wedge Pressure

1.A family of structurally related but genetically distinct natriuretic peptides exist which include atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) of myocardial cell origin and C-type natriuretic peptide (CNP) of endothelial and renal epithelial cell origin. All three exert actions via cGMP, with ANP and BNP functioning via the natriuretic peptide A receptor and CNP via the natriuretic peptide B receptor. 2.Circulating and urinary natriuretic peptides were determined in response to acute intravascular volume overload (AVO). Additionally, their functional role in cardiorenal regulation during AVO was investigated by utilizing the natriuretic peptide receptor antagonist HS-142-1. Control (n = 5) and study dogs (HS-142-1, n = 9) underwent AVO with normal saline equal to 10% of body weight over 1 ;h. Both groups demonstrated similar significant increases in right atrial pressure, pulmonary capillary wedge pressure, pulmonary artery pressure and cardiac output. Circulating ANP paralleled increases in right atrial pressure and pulmonary capillary wedge pressure, with no changes in plasma BNP or CNP. At peak AVO, urinary CNP excretion was increased compared with baseline (7.0±4.2 versus 62±8.0 ;pg/min, P< 0.05). 3.In the HS-142-1-treated group, plasma cGMP was decreased compared with the control group (9.6±1.1 to 5.0±1.2 ;pmol/ml, P< 0.05). A significant attenuation of natriuresis (566±91 versus 1241±198 ;μEq/min, P< 0.05) and diuresis (4.8±0.7 versus 10.1±2.0 ;ml/min, P< 0.05) was also observed at peak AVO in the HS-142-1 treated group. 4.These findings support differential and selective responses of the three natriuretic peptides to AVO, in which plasma ANP and urinary CNP are markers for AVO. Secondly, these studies confirm the role of ANP and CNP but not BNP in the natriuretic and diuretic response to acute volume overload.

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