scholarly journals Cardiac index predicts long-term outcomes in patients with heart failure

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252833
Author(s):  
Tatsuro Ibe ◽  
Hiroshi Wada ◽  
Kenichi Sakakura ◽  
Yusuke Ugata ◽  
Hisataka Maki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Index ◽  
Right Heart Catheterization ◽  
Right Atrial ◽  
Major Adverse Cardiovascular Events ◽  
Heart Catheterization ◽  
Long Term Outcomes ◽  
Cardiac Outcomes ◽  
Patients With Heart Failure

Background The role of cardiac index (CI) and right atrial pressure (RAP) for predicting long-term outcomes of heart failure has not been well established. The aim of this study was to investigate long-term cardiac outcomes in patients with heart failure having various combinations of CI and RAP. Methods A total of 787 heart failure patients who underwent right-heart catheterization were retrospectively categorized into the following four groups: Preserved CI (≥2.5 L/min/m2) and Low RAP (<8 mmHg) (PRE-CI/L-RAP; n = 285); Preserved CI (≥2.5 L/min/m2) and High RAP (≥8 mmHg) (PRE-CI/H-RAP; n = 242); Reduced CI (<2.5 L/min/m2) and Low RAP (<8 mmHg) (RED-CI/L-RAP; n = 123); and Reduced CI (<2.5 L/min/m2) and High RAP (≥8 mmHg) (RED-CI/H-RAP; n = 137). Survival analysis was applied to investigate which groups were associated with major adverse cardiovascular events (MACE). Results The RED-CI/L-RAP and RED-CI/H-RAP groups were significantly associated with MACE as compared with the PRE-CI/L-RAP and PRE-CI/H-RAP groups after adjustment for confounding factors (RED-CI/L-RAP vs. PRE-CI/L-RAP: HR 2.11 [95% CI 1.33–3.37], p = 0.002; RED-CI/H-RAP vs. PRE-CI/L-RAP: HR 2.18 [95% CI 1.37–3.49], p = 0.001; RED-CI/L-RAP vs. PRE-CI/H-RAP: HR 1.86 [95% CI 1.16–3.00], p = 0.01; RED-CI/H-RAP vs. PRE-CI/H-RAP: HR 1.92 [95% CI 1.26–2.92], p = 0.002), whereas the difference between the RED-CI/H-RAP and RED-CI/L-RAP groups was not significant (HR 1.03 [95% CI 0.64–1.66], p = 0.89). Conclusions The hemodynamic severity categorized by CI and RAP levels provided clear risk stratification in patients with symptomatic heart failure. Low CI was an independent predictor of long-term cardiac outcomes.

Abstract 15161: Increased Right Atrial Stiffness in Patients With Heart Failure With Preserved Ejection Fraction and Pulmonary Hypertension

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jessie van Wezenbeek ◽  
Arno van der Bovenkamp ◽  
Jeroen N Wessels ◽  
Sophia-Anastasia Mouratoglou ◽  
Marie Jose Goumans ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Ejection Fraction ◽  
Right Heart Catheterization ◽  
Right Atrial ◽  
Heart Catheterization ◽  
Preserved Ejection Fraction ◽  
Chamber View ◽  
Patients With Heart Failure ◽  
Pulmonary Arterial

Background: Patients with Heart Failure with preserved Ejection Fraction (HFpEF) and Pulmonary Hypertension (PH) have increased right atrial (RA) pressures. Whether the higher RA pressures are related to increased afterload or overall stiffening of the heart is unknown. The aim of this study is to gain further insight into the right atrium in HFpEF-PH. Methods: This is a retrospective analysis of patients with HFpEF (no PH), HFpEF-PH and Pulmonary Arterial Hypertension (PAH) that underwent right heart catheterization and cardiac magnetic resonance (CMR) imaging. CMR was used to determine RA function by quantifying volume and strain on the 4-chamber view. Total, passive and active RA emptying fraction (RAEF) were calculated. RA stiffness was calculated by determining the slope of maximum and minimum pressure during v-wave and minimal and maximal RA volumes. Groups were compared with ANOVA and post-hoc comparison with Bonferroni correction. Results: 176 patients were included: 13 HFpEF, 33 HFpEF-PH and 130 PAH patients. Although afterload was lower in PAH and higher in HFpEF patients, as shown by mean pulmonary arterial pressure (mPAP) (41 ± 2 mmHg in HFpEF-PH vs 53 ± 21 mmHg in PAH vs 19 ± 1 mmHg in HFpEF, p<0.001) and pulmonary vascular resistance (PVR) (2.3 ± 0.3 wu/m 2 in HFpEF-PH vs 5.7 ± 0.2 wu/m 2 in PAH vs 0.4 ± 0.06 wu/m 2 in HFpEF, p<0.001), mean RA pressure was significantly higher in HFpEF-PH patients compared to both groups (Figure 1A). HFpEF-PH patients had significantly increased RA stiffness compared to HFpEF and PAH patients (Figure 1B). Total RAEF was reduced in HFpEF-PH compared to PAH and HFpEF patients: passive RAEF was similar, but active RAEF was slightly reduced in HFpEF-PH (Figure 1C). This was in line with measurements of RA longitudinal strain (Figure 1D). Conclusions: Despite lower afterload, HFpEF-PH patients have worse RA function and increased RA stiffness compared to PAH. Higher RA pressures in HFpEF-PH may reflect additional stiffening of the heart.

scholarly journals Echocardiographic and Hemodynamic Parameters Associated with Diminishing Renal Filtration among Patients with Heart Failure with Preserved Ejection Fraction

2018 ◽  
Vol 9 (2) ◽  
pp. 83-91 ◽  
Author(s):  
Kevin Bryan Lo ◽  
Kene Mezue ◽  
Pradhum Ram ◽  
Abhinav Goyal ◽  
Mahek Shah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Renal Dysfunction ◽  
Pressure Ratio ◽  
Left Ventricular ◽  
Right Atrial ◽  
Heart Catheterization ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure

Background: Renal dysfunction is an important predictor of poor outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Right ventricular (RV) dysfunction is implicated as one of the explanations for worsening renal function in cardiorenal syndrome. Novel right heart catheterization (RHC) parameters such as pulmonary artery pulsatility index (PAPi) and right atrial to pulmonary capillary wedge pressure ratio (RA:PCWP) have been found as predictors of RV dysfunction. However, most studies investigating these parameters have been done in the setting of myocardial infarction or left ventricular assist device implantation, with limited data on these metrics in patients with HFpEF. Objective: The purpose of this study was to determine whether novel RHC parameters such as RA:PCWP and PAPi correlate with long-term renal outcomes among patients with HFpEF. Methods: A retrospective single-center study of adult patients with a documented diagnosis of heart failure who had RHC was performed between January 2006 and December 2010 at Einstein Med ical Center Philadelphia. Selected patients also had a serum B-type natriuretic peptide level ≥100 pg/mL and a PCWP ≥15 mm Hg. Patients with an ejection fraction < 50%, including those with recovered ejection fraction, and end-stage renal disease were excluded. Results: A total of 81 patients with a clinical diagnosis of HFpEF were identified who met the inclusion criteria. On multivariate analysis, after adjusting for age, sex, race, diabetes, hypertension, and cardiac index, PAPi was associated with long-term estimated glomerular filtration rate (eGFR) (β = 3.43, 95% CI = 0.635–6.23, p = 0.017), and RA:PCWP showed a trend towards significance (β = 14.81, 95% CI = –0.096–29.73, p = 0.051). The results were unchanged after further adjustment for eGFR at the time of RHC. Conclusion: Novel hemodynamic indices obtained by RHC may have predictive value for long-term renal dysfunction in patients with HFpEF.

Impact of New Grading System and New Hemodynamic Classification on Long-Term Outcome in Patients With Severe Tricuspid Regurgitation

2021 ◽  
Vol 14 (2) ◽  
Author(s):  
Taku Omori ◽  
Goki Uno ◽  
Shunsuke Shimada ◽  
Florian Rader ◽  
Robert J. Siegel ◽  
...  
Keyword(s):  
Cardiac Index ◽  
Tricuspid Regurgitation ◽  
Cardiovascular Events ◽  
Right Heart Catheterization ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Heart Catheterization ◽  
Grading System ◽  
Right Heart

Background: A new grading of tricuspid regurgitation (TR) beyond severe has been proposed. However, few studies assessing the validity of such a new grading scheme of TR have been conducted. Therefore, we evaluated associations of TR grades beyond severe with patient outcome and hemodynamics. Methods: We retrospectively studied patients who underwent 2-dimensional echocardiography and were diagnosed with severe TR between January 2014 and December 2015. According to the vena contracta width of TR (VC), the patients were classified into 2 groups: VC under 14 mm (VC<14 mm) and VC 14 mm or greater (VC≥14 mm). Hemodynamic parameters were estimated by echocardiography and were obtained by right heart catheterization. Cardiovascular events were defined as cardiovascular death or admission for heart failure. Results: A total of 679 patients (mean 72±17 years, 56% women) were included. During follow-up (median, 158 days; range, 29–891), 210 patients experienced cardiovascular events. By multivariate analysis, VC≥14 mm and left ventricular ejection fraction were independent predictors of cardiovascular events (hazard ratio, 1.57 [1.06–2.33]; hazard ratio, 0.99 [0.98–0.99], respectively). Patients with VC≥14 mm had significantly lower cardiac index (median, 1.8 versus 2.1 L/min per m 2 , P =0.001) and a higher prevalence of right atrial pressure 15 mm Hg (74% versus 60%, P <0.001) on echocardiography. Also, right heart catheterization confirmed higher right atrial pressure in patients with VC≥14 mm than those with VC<14 mm (16±8 versus 12±6 mm Hg, P =0.004). The new subset classification developed by cardiac index and right atrial pressure both on echocardiography predicted cardiovascular events (Log-rank P <0.001). Conclusions: The relationship of VC≥14 mm to adverse outcome and poor hemodynamics showed the clinical relevance and need of a new grading system beyond severe. The new hemodynamic subset classification provides additional prognostic value for cardiovascular events in patients with severe TR.

Abstract 16244: Point of Care Ultrasound of the Jugular Venous Pulse in the Upright Position (u 2 Jvp) Predicts Elevated Right Atrial Pressure and Pulmonary Capillary Wedge Pressure on Right Heart Catheterization in Obese and Non-obese Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Libo Wang ◽  
Jonathan Harrison ◽  
Elizabeth Dranow ◽  
Lillian Khor
Keyword(s):  
Heart Failure ◽  
Predictive Value ◽  
Point Of Care ◽  
Right Heart Catheterization ◽  
Upright Position ◽  
Right Atrial ◽  
Heart Catheterization ◽  
Point Of Care Ultrasound ◽  
Right Heart ◽  
Clinically Significant

Introduction: Accurate intravascular volume status assessment is central to heart failure management, but current non-invasive bedside techniques remain a challenge. The visual inspection of jugular venous pulsation (JVP) in a reclined position and measuring its height from the sternal notch has been used as a surrogate for right atrial pressure (RAP). There are no studies on the predictive value of a visible internal jugular vein (IJV) in the upright position (U 2 JVP). Hypothesis: Point of care ultrasound (POCUS) for volume assessment in the upright position is predictive of clinically significant hypervolemia. Methods: Adult patients undergoing right heart catheterization (RHC) were enrolled prior for IJV imaging with point of care ultrasound (POCUS) device, Butterfly iQ™. The IJV and its size in comparison to the carotid artery was identified on ultrasound with the patient upright. Elevated RAP and PCWP was present if the IJV was still visible and not collapsed throughout the entirety of the respiratory cycle. Valsalva was used to confirm the position of a collapsed IJV. Results: 72 participants underwent U 2 JVP assessment on the same day prior to RHC. Average BMI was 31.9 kg/m2. The area under the curve (AUC) of U 2 JVP predicting RAP greater than 10 mmHg and PCWP of 15 mmhg or higher on RHC was 0.78 (95% CI 0.66-0.9, p<0.001), with AUC of 0.86 and 0.74 for non-obese and obese subgroups respectively, p= 0.38. The finding of a visible U 2 JVP in the upright position was 70.6 % sensitive and 85.5 % specific with a negative predictive value of 90.4% for identifying both RAP greater than 10 mmHg and PCWP equal or greater than 15 mmHg. Conclusions: The U 2 JVP is novel and pragmatic bed-side approach to the assessment of clinically significant elevated intra-cardiac pressures in our increasingly obese heart failure population.

scholarly journals Effects of a 9-Week Hybrid Comprehensive Telerehabilitation Program on Long-term Outcomes in Patients With Heart Failure

2020 ◽  
Vol 5 (3) ◽  
pp. 300 ◽  
Author(s):  
Ewa Piotrowicz ◽  
Michael J. Pencina ◽  
Grzegorz Opolski ◽  
Wojciech Zareba ◽  
Maciej Banach ◽  
...  
Keyword(s):  
Heart Failure ◽  
Long Term Outcomes ◽  
Patients With Heart Failure

scholarly journals Discordant Short- and Long-Term Outcomes Associated With Diabetes in Patients With Heart Failure: Importance of Age and Sex

2008 ◽  
Vol 1 (4) ◽  
pp. 234-241 ◽  
Author(s):  
Michael R. MacDonald ◽  
Pardeep S. Jhund ◽  
Mark C. Petrie ◽  
James D. Lewsey ◽  
Nathaniel M. Hawkins ◽  
...  
Keyword(s):  
Heart Failure ◽  
Long Term Outcomes ◽  
Patients With Heart Failure ◽  
Short And Long Term ◽  
Age And Sex

scholarly journals 138 Exercise haemodynamics in heart failure with preserved ejection fraction: a systematic review and meta-analysis

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Claudia Baratto ◽  
Sergio Caravita ◽  
Davide Soranna ◽  
Céline Dewachter ◽  
Antoine Bondue ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Body Position ◽  
Meta Analysis ◽  
Right Heart Catheterization ◽  
Standard Test ◽  
Right Atrial ◽  
Peak Exercise ◽  
Heart Catheterization ◽  
Preserved Ejection Fraction

Abstract Aims Exercise right heart catheterization (RHC) is considered the gold-standard test to diagnose heart failure with preserved ejection fraction (HFpEF). However, exercise RHC is an insufficiently standardized technique, and current haemodynamic thresholds to define HFpEF are not universally accepted. We sought to describe the exercise haemodynamics profile of HFpEF cohorts reported in literature, as compared with control subjects. Methods and results We performed a systematic literature review until December 2020. Studies reporting pulmonary artery wedge pressure (PAWP) at rest and peak exercise were extracted. Summary estimates of all haemodynamic variables were evaluated, stratified according to body position (supine/upright exercise), and the PAWP/cardiac output (CO) slope during exercise was extrapolated. Twenty-eight studies were identified, providing data for 2230 HFpEF patients and 706 controls. At peak exercise, patients with HFpEF achieved higher PAWP [30 (29–31) vs. 16 (15–17) mmHg, P &lt; 0.001] and mean right atrial pressure (P &lt; 0.001) than controls. These differences persisted after adjustment for age, sex, body mass index, body position. However, peak PAWP values were highly heterogeneous among the cohorts, with a relative overlap with controls. PAWP/CO slope was steeper in HFpEF than in controls [3.81 (3.24–4.38) vs. 0.91 (0.24–1.58) mmHg/l/min, P &lt; 0.001], even after adjustment for covariates (P = 0.020) (Figure). Conclusions The haemodynamic profile of HFpEF patients is consistent across studies and characterized by a higher left and right filling pressure at rest, magnified by physical exercise. Our analysis strongly suggests that PAWP/CO slope might allow for a more consistent identification of HFpEF, irrespective of body position. This variable likely overcomes the shortcomings of an isolated peak PAWP measurement, allowing for a more univocal identification of HFpEF in patients with unexplained dyspnoea.

scholarly journals A051 Long-term Outcomes for Patients with Heart Failure in New Zealand according to Ejection Fraction Phenotype

2020 ◽  
Vol 29 ◽  
pp. S21-S22
Author(s):  
T. Evans ◽  
K. Poppe ◽  
C. Choi ◽  
G. Devlin ◽  
M. Lund ◽  
...  
Keyword(s):  
Heart Failure ◽  
New Zealand ◽  
Ejection Fraction ◽  
Long Term Outcomes ◽  
Patients With Heart Failure

Abstract 13180: Ultrasound Jugular Venous Pressure Collapse Point Predicts Elevated Right Atrial Pressure on Right Heart Catheterization in Obese and Nonobese Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Libo Wang ◽  
Jonathan Harrison ◽  
Elizabeth Dranow ◽  
Lillian Khor
Keyword(s):  
Heart Failure ◽  
Venous Pressure ◽  
Right Heart Catheterization ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Heart Catheterization ◽  
Point Of Care Ultrasound ◽  
Right Heart ◽  
Simplified Approach

Introduction: Accurate intravascular volume status assessment is central to heart failure management, but current non-invasive bedside techniques remain a challenge. Visual inspection of jugular venous pulsation (JVP) is used as a surrogate for central venous pressure (CVP). Studies have shown variability and inaccuracy of the JVP exam in estimating CVP or right atrial pressure (RAP). Published methods of RAP estimation through internal jugular vein (IJV) ultrasonography are either complex or require offline analysis. We validated a simplified approach to ultrasonography of the JVP (uJVP) as a method to predict RAP. Methods: Adult patients undergoing right heart catheterization (RHC) were enrolled prior for IJV imaging with point of care ultrasound (POCUS) device, Butterfly iQ™. The IJV was identified on ultrasound with the patient reclined (head of bed between 30-45°) and followed cranially until tapering smaller than the adjacent carotid artery throughout the entirety of the respiratory cycle. The height of this collapse point from the sternal angle added to 5 centimeters was defined as ultrasound JVP (uJVP). Results: 77 participants underwent uJVP assessment on the same day prior to RHC. Average BMI was 33 kg/m 2 . The area under the curve (AUC) of uJVP and RAP greater than 10mmHg on RHC was 0.879 (95% CI 0.759-0.931, p<0.001), with AUC of 0.972 and 0.818 for non-obese and obese subgroups respectively, and AUC of 0.876 for elevated RAP and pulmonary capillary wedge pressure (PCWP). A uJVP cutoff of 9 or higher was 85% sensitive and 72% specific at identifying RAP greater than 10mmHg. Conclusion: We developed and validated a novel technique identifying the uJVP using POCUS which correlates with invasive RAP regardless of obesity. This technique predicted combined elevated left and right sided intracardiac pressures. The uJVP’s potential to enhance the diagnostic value of the bed-side examination in an increasingly obese heart failure population warrants further research.

Sign in / Sign up

Export Citation Format

Share Document