Pulmonary artery catheters in acute heart failure: end of an era?

Abstract Background Appropriate pulmonary artery catheter (PAC) use may effectively decrease mortality in acute heart failure patients. The concept that the pulmonary artery catheter (PAC) is a valuable tool for hemodynamic monitoring when used in appropriately selected patients and by physicians trained well to interpret and apply the data correctly provided has not been evaluated adequately yet in acute heart failure patients with preserved ejection fraction (HFpEF). Methods The PERSUIT-HFpEF Registry is a prospective, observational, multicenter cohort study on prognosis of HFpEF in Japan. Patients hospitalized for heart failure (diagnosed by using Framingham criteria) who met both of the following criteria were enrolled: 1) a left ventricular ejection fraction of 50% or more as measured at the local site by echocardiography; 2) an elevated level of N terminal pro brain natriuretic peptide (NT proBNP) (400 pg per milliliter or more) or brain natriuretic peptide (BNP) (100 pg per milliliter or more). In the present study, we evaluated the impact of PAC on all-cause death of the patients with HFpEF. PAC use was left at the discretion of attending physicians. Results The PERSUIT-HFpEF Registry enrolled 486 patients (81±9 years, 259 females, mean follow-up duration 198±195 days). Of these, data of PAC usage was available in 434 patients. Patients were further stratified according to use of a PAC: PAC 153 patients vs. non-PAC 281 patients. Length of hospitalization was numerically shorter in the PAC group than in the non-PAC group [20.3±14.7 vs. 22.5±17.4 days, p=0.182]. Kaplan-Meier estimated 1-year all-cause death rate was significantly lower in the PAC group than in the non-PAC group (9.5% vs. 19.1%, p=0.019). PAC use was associated with significant risk reduction of all-cause death [hazard ratio (HR) 0.425, 95% confidence interval (CI), 0.203–0.890, p=0.023] in the crude analysis. The significant risk reduction still existed after multivariate adjustment including potential confounders [HR 0.427, 95% CI, 0.185–0.984, p=0.046] Kaplan Meier analysis Conclusions In the real-world Asian registry data, PAC use was associated with the improved all-cause death rate, suggesting that the PAC might be a useful guidance tool for treatment of the patients with HFpEF. Acknowledgement/Funding Roche diagnostics FUJIFILM Toyama Chemical

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A Case of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Developed Acute Heart Failure by Transcatheter Ductus Arteriosus Closure

Pediatric Cardiology and Cardiac Surgery ◽

10.9794/jspccs.32.518 ◽

2016 ◽

Vol 32 (6) ◽

pp. 518-523

Author(s):

Hidenori Yamamoto ◽

Naoki Ohashi ◽

Hiroshi Nishikawa ◽

Sho Takeda ◽

Shuichiro Yoshida ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery ◽

Pulmonary Artery ◽

Acute Heart Failure ◽

Left Coronary Artery ◽

Ductus Arteriosus ◽

Anomalous Origin

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Pathophysiology and clinical assessment of the cardiovascular system (including pulmonary artery catheter)

10.1093/med/9780199687039.003.0014 ◽

2015 ◽

Author(s):

Romain Barthélémy ◽

Etienne Gayat ◽

Alexandre Mebazaa

Keyword(s):

Heart Failure ◽

Pulmonary Artery ◽

Right Ventricular ◽

Pulmonary Artery Catheter ◽

Acute Heart Failure ◽

Ventricular Dysfunction ◽

Systolic Dysfunction ◽

Right Ventricular Dysfunction ◽

Left Ventricular ◽

Haemodynamic Instability

Haemodynamic instability in acute cardiac care may be related to various mechanisms, including hypovolaemia and heart and/or vascular dysfunction. Although acute heart failure patients are often admitted for dyspnoea, many mechanisms can be involved, including left ventricular diastolic and/or systolic dysfunction and/or right ventricular dysfunction. Many epidemiological studies show that clinical signs at admission, morbidity, and mortality differ between the main scenarios of acute heart failure: left ventricular diastolic dysfunction, left ventricular systolic dysfunction, right ventricular dysfunction, and cardiogenic shock. Although echocardiography often helps to assess the mechanism of cardiac dysfunction, it cannot be considered as a monitoring tool. In some cases (in particular, in cases of refractory shock secondary to both vascular and heart dysfunction or in cases of refractory haemodynamic instability associated with severe hypoxaemia), pulmonary artery catheter can help to assess and monitor cardiovascular status and to evaluate response to treatments. Last, macro- and microvascular dysfunctions are also important determinants of haemodynamic instability.

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Impact of pulmonary artery catheter on outcome in patients with acute heart failure syndromes with hypotension or receiving inotropes: From the ATTEND Registry

International Journal of Cardiology ◽

10.1016/j.ijcard.2013.12.174 ◽

2014 ◽

Vol 172 (1) ◽

pp. 165-172 ◽

Cited By ~ 23

Author(s):

Yohei Sotomi ◽

Naoki Sato ◽

Katsuya Kajimoto ◽

Yasushi Sakata ◽

Masayuki Mizuno ◽

...

Keyword(s):

Heart Failure ◽

Pulmonary Artery ◽

Pulmonary Artery Catheter ◽

Acute Heart Failure ◽

Acute Heart Failure Syndromes

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Pathophysiology and clinical assessment of the cardiovascular system (including pulmonary artery catheterization)

The ESC Textbook of Intensive and Acute Cardiovascular Care ◽

10.1093/med/9780198849346.003.0012 ◽

2021 ◽

pp. 115-126

Author(s):

Alessandro Sionis ◽

Etienne Gayat ◽

Alexandre Mebazaa

Keyword(s):

Heart Failure ◽

Pulmonary Artery ◽

Right Ventricular ◽

Cardiovascular System ◽

Acute Heart Failure ◽

Ventricular Dysfunction ◽

Systolic Dysfunction ◽

Right Ventricular Dysfunction ◽

Left Ventricular ◽

Ventricular Diastolic Dysfunction

The underlying pathophysiological derangements of the cardiovascular system in many medical conditions are often complex. Acute circulatory dysfunction can be related broadly to a cardiogenic cause leading to acute heart failure or be secondary to hypovolaemia or vascular dysfunction (e.g. sepsis). Different mechanisms may be involved, including left ventricular diastolic and/or systolic dysfunction and/or right ventricular dysfunction. Many aspects of left ventricular function are explained by considering ventricular pressure–volume characteristics. Epidemiological studies show that clinical signs at admission, morbidity, and mortality differ between the main scenarios of acute heart failure: left ventricular diastolic dysfunction, left ventricular systolic dysfunction, right ventricular dysfunction, and cardiogenic shock. Although echocardiography is usually the first investigation used to assess the mechanism of cardiac dysfunction, in selected cases (in particular, in cases of refractory shock secondary to both vascular and heart dysfunction or in cases of refractory haemodynamic instability associated with severe hypoxaemia), the pulmonary artery catheter can help to assess and monitor the cardiovascular status and evaluate response to treatments.

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