Correlation of Limb Bioimpedance to Echocardiographic Indicators of Congestion in Patients with NYHA Class II/III Heart Failure (Preprint)

2018 ◽  
Author(s):  
Andrew Accardi ◽  
Thomas Heywood ◽  
Anne Daleiden-Burns
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Fluid Overload ◽  
Nyha Class ◽  
Systolic Pressure ◽  
Class Ii ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Pulmonary Artery Systolic Pressure

BACKGROUND The treatment of heart failure (HF) in the United States is estimated to exceed $30 billion each year and is anticipated to increase to a staggering $70 billion by the year 2030. This makes the management of HF one of the leading challenges Medicare will face in the years to come. Traditional methods to detect impending congestion such as body weight and physical examination findings are often non-specific and lack sensitivity making them inadequate to recognize fluid overload and prevent decompensation. It has been suggested that bioimpedance spectroscopy (BIS) can be used as a surrogate marker for detecting fluid overload and therefore, serve as an adjunct to clinical exam findings. OBJECTIVE This study examines the relationship between a BIS device and echocardiographic parameters associated with volume overload with same day measurements in the first 8 patients with NYHA Class II/III HF on an IRB approved protocol. METHODS Each patient was followed 3 times a week for 4 weeks within the hospital outpatient setting. At each visit BIS measures were recorded for whole body as well as arms and legs. Additionally, signs and symptoms, weight and echocardiograph findings were all recorded. RESULTS Correlations of BIS measurements with echo parameters were performed. The leg impedance measurement correlated strongly with echo findings; inferior vena cava (IVC) size (p=0.001), right atrial pressure (RAP) (p<0.001), and pulmonary artery systolic pressure (PAS) measurements (p<0.001). CONCLUSIONS Preliminary findings demonstrated excellent correlations with BIS measurements and IVC size, right atrial pressure and pulmonary artery systolic pressure measurements which suggest a possible alternative method to detect fluid overload despite the small sample size. Trending a patient's impedance using the SOZO device at home or the practitioner's office may assist clinicians in providing more accurate, individualized HF care.  CLINICALTRIAL . IRB approval was obtained for this study (Scripps IRB #IRB-16-6852).

scholarly journals Accuracy and Diagnostic Performance of Doppler Echocardiography to Estimate Mean Pulmonary Artery Pressure in Heart Failure

2021 ◽  
Author(s):  
Alva Bjorkman ◽  
Lars H. Lund ◽  
Ulrika Faxen ◽  
Per Lindqvist ◽  
Ashwin Venkateshvaran
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Doppler Echocardiography ◽  
Diagnostic Performance ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Artery Pressure ◽  
Strong Ability

BACKGROUND. Multiple Doppler Echocardiography (DE) algorithms have been proposed to estimate mean pulmonary artery pressure (PAP) and assess pulmonary hypertension (PH) likelihood. We assessed the accuracy of 4 different DE approaches to estimate PAP in patients with heart failure (HF) undergoing near-simultaneous right heart catheterization (RHC), and compared their diagnostic performance to identify PH with recommendation-advised tricuspid regurgitation peak velocity (TRV). METHODS. PAP was retrospectively assessed in 112 HF patients employing 4 previously validated DE algorithms. Association and agreement with invasive PAP were assessed. Diagnostic performance of DE methods vs. TRV=2.8m/sec to identify invasive PAP ≥ 25mmHg were compared. RESULTS. All DE algorithms demonstrated reasonable association (r = 0.41 to 0.65; p<0.001) and good agreement with invasive PAP, with relatively lower mean bias and higher precision observed in algorithms that included TRV or velocity time integral. All methods demonstrated strong ability (AUC=0.70-0.80; p<0.001) to identify PH but did not outperform TRV (AUC=0.84; p<0.001). Echocardiographic estimates of right atrial pressure were considered in 3 of 4 DE algorithms and falsely elevated in as many as 30% of patients. CONCLUSIONS. Echocardiographic estimates of PAP demonstrate reasonable accuracy to represent invasive PAP and strong ability to identify PH in HF. However, even the best performing algorithm did not outperform recommendation-advised TRV. The additional value of echocardiographic estimates of right atrial pressure may need to be re-evaluated.

Development of a circulatory mock loop for biventricular device testing with various heart conditions

2020 ◽  
Vol 43 (9) ◽  
pp. 600-605 ◽  
Author(s):  
Yuichiro Kado ◽  
Takuma Miyamoto ◽  
David J Horvath ◽  
Shengqiang Gao ◽  
Kiyotaka Fukamachi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Left Atrial ◽  
Aortic Pressure ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Artery Pressure

This study aimed to evaluate a newly designed circulatory mock loop intended to model cardiac and circulatory hemodynamics for mechanical circulatory support device testing. The mock loop was built with dedicated ports suitable for attaching assist devices in various configurations. This biventricular mock loop uses two pneumatic pumps (Abiomed AB5000™, Danvers, MA, USA) driven by a dual-output driver (Thoratec Model 2600, Pleasanton, CA, USA). The drive pressures can be individually modified to simulate a healthy heart and left and/or right heart failure conditions, and variable compliance and fluid volume allow for additional customization. The loop output for a healthy heart was tested at 4.2 L/min with left and right atrial pressures of 1 and 5 mm Hg, respectively; a mean aortic pressure of 93 mm Hg; and pulmonary artery pressure of 17 mm Hg. Under conditions of left heart failure, these values were reduced to 2.1 L/min output, left atrial pressure = 28 mm Hg, right atrial pressure = 3 mm Hg, aortic pressure = 58 mm Hg, and pulmonary artery pressure = 35 mm Hg. Right heart failure resulted in the reverse balance: left atrial pressure = 0 mm Hg, right atrial pressure = 30 mm Hg, aortic pressure = 100 mm Hg, and pulmonary artery pressure = 13 mm Hg with a flow of 3.9 L/min. For biventricular heart failure, flow was decreased to 1.6 L/min, left atrial pressure = 13 mm Hg, right atrial pressure = 13 mm Hg, aortic pressure = 52 mm Hg, and pulmonary artery pressure = 18 mm Hg. This mock loop could become a reliable bench tool to simulate a range of heart failure conditions.

Abstract 15388: Persistent Pulmonary Hypertension After Transcatheter Aortic Valve Implantation: Impact on Mortality

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Maria Drakopoulou ◽  
Konstantinos Stathogiannis ◽  
Konstantinos Toutouzas ◽  
George Latsios ◽  
Andreas Synetos ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Aortic Stenosis ◽  
Pulmonary Artery ◽  
Severe Aortic Stenosis ◽  
Systolic Pressure ◽  
Right Atrial ◽  
Pulmonary Artery Systolic Pressure ◽  
End Point ◽  
The Right ◽  
The Impact

Objective: Severe aortic stenosis leads to increased pulmonary arterial systolic pressure. A controversy still remains regarding the impact of persistent pulmonary hypertension (PHT) on prognosis of patients undergoing transcatheter aortic valve implantation (TAVI). We sought to investigate the impact of persistent PHT on 2-year all-cause mortality of patients with severe aortic stenosis following TAVI. Methods: Patients with severe and symptomatic aortic stenosis (effective orifice area [EOA]≤1 cm 2 ) who were scheduled for TAVI with a self-expanding valve at our institution were prospectively enrolled. Prospectively collected echocardiographic data before and after TAVI were retrospectively analyzed in all patients. Pulmonary artery systolic pressure was estimated as the sum of the right ventricular to the right atrial gradient during systole and the right atrial pressure. PHT following TAVI was classified as absent if <35 mmHg and persistent if ≥35 mmHg. Primary clinical end-point was 2-year all-cause mortality defined according to the criteria proposed by the Valve Academic Research Consortium-2. Results: Hundred and forty patients (mean age: 82±9 years) were included in the study. The primary clinical end point occurred in 17 patients (12%) during a median follow-up period of 2 years. Mean pulmonary artery systolic pressure was reduced in all patients following TAVI (45±9 versus 41±6 mmHg, p<0.01). Mortality rate was higher in patients with persistent PHT compared to patients with normal pulmonary artery systolic pressure following TAVI (26% versus 14 %, p<0.01). Patients that reached the primary clinical end point had a higher post procedural mean systolic pulmonary pressure (43±9 versus 39±6 mmHg, p=0.02). In multivariate regression analysis, persistence of PHT (OR: 2.51, 95% CI: 1.109-7.224, p=0.01) was an independent predictor of long-term mortality. Conclusions: The persistence of pulmonary hypertension after TAVI is associated with long term mortality. Identifying the population that will clearly benefit from TAVI is still need to be validated by larger trials.

Abstract 3143: Reverse Hemodynamic Remodelling May Be Possible Over Time

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Lynne W Stevenson ◽  
Yong K Cho ◽  
J. T Heywood ◽  
Robert C Bourge ◽  
William T Abraham ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Nyha Class ◽  
Systolic Pressure ◽  
Filling Pressure ◽  
Class Iii ◽  
One Year ◽  
Over Time

Introduction : Elevated filling pressures are a hallmark of chronic heart failure. They can be reduced acutely during HF hospitalization but the hemodynamic impact of ongoing therapy to maintain optivolemia has not been established. Methods and Results : After recent HF hospitalization, 274 NYHA Class III or IV HF patients were enrolled in the COMPASS-HF study at 28 experienced HF centers and received intense HF management (average 24.7 staff contacts/ 6 months) ± access to filling pressure information to adjust diuretics to maintain optivolemia, usually defined as estimated pulmonary artery diastolic (PAD) pressure of 12±4 mmHg. Filling pressure information was available for half the patients during the first 6 months (the Chronicle group, <Access), and for all patients during the next 6 months. Diuretics were adjusted 12.7 times per patient in the Chronicle group and 8.2 times per patient in the Control (-Access) group during the first 6 months (p = 0.0001). Compared to baseline, decreases in RV systolic pressure (RVSP) and ePAD were significant for the +Access patients by one year (p=0.0012 and p =.04, respectively). The Control patients exhibited a similar trend 6 months after crossing to +Access (figure ). Conclusions: Targeted therapeutic adjustments, based on continuous filling pressures along with intensification of HF management contacts, are associated with a reduction in chronic left-sided filling pressures and right ventricular load.

scholarly journals Noninvasive evaluation of pulmonary artery pressure during exercise: the importance of right atrial hypertension

2019 ◽  
Vol 55 (2) ◽  
pp. 1901617 ◽  
Author(s):  
Masaru Obokata ◽  
Garvan C. Kane ◽  
Hidemi Sorimachi ◽  
Yogesh N.V. Reddy ◽  
Thomas P. Olson ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Pressure Gradient ◽  
Systolic Pressure ◽  
Area Under The Curve ◽  
Right Atrial ◽  
Pulmonary Artery Systolic Pressure ◽  
Therapeutic Implications ◽  
Exercise Induced ◽  
The Right ◽  
Minimal Bias

IntroductionIdentification of elevated pulmonary artery pressures during exercise has important diagnostic, prognostic and therapeutic implications. Stress echocardiography is frequently used to estimate pulmonary artery pressures during exercise testing, but data supporting this practice are limited. This study examined the accuracy of Doppler echocardiography for the estimation of pulmonary artery pressures at rest and during exercise.MethodsSimultaneous cardiac catheterisation-echocardiographic studies were performed at rest and during exercise in 97 subjects with dyspnoea. Echocardiography-estimated pulmonary artery systolic pressure (ePASP) was calculated from the right ventricular (RV) to right atrial (RA) pressure gradient and estimated RA pressure (eRAP), and then compared with directly measured PASP and RAP.ResultsEstimated PASP was obtainable in 57% of subjects at rest, but feasibility decreased to 15–16% during exercise, due mainly to an inability to obtain eRAP during stress. Estimated PASP correlated well with direct PASP at rest (r=0.76, p<0.0001; bias −1 mmHg) and during exercise (r=0.76, p=0.001; bias +3 mmHg). When assuming eRAP of 10 mmHg, ePASP correlated with direct PASP (r=0.70, p<0.0001), but substantially underestimated true values (bias +9 mmHg), with the greatest underestimation among patients with severe exercise-induced pulmonary hypertension (EIPH). Estimation of eRAP during exercise from resting eRAP improved discrimination of patients with or without EIPH (area under the curve 0.81), with minimal bias (5 mmHg), but wide limits of agreement (−14–25 mmHg).ConclusionsThe RV–RA pressure gradient can be estimated with reasonable accuracy during exercise when measurable. However, RA hypertension frequently develops in patients with EIPH, and the inability to noninvasively account for this leads to substantial underestimation of exercise pulmonary artery pressures.

scholarly journals Prognostic Role of Subclinical Congestion in Heart Failure Outpatients: Focus on Right Ventricular Dysfunction

2021 ◽  
Vol 10 (22) ◽  
pp. 5423
Author(s):  
Andrea Lorenzo Vecchi ◽  
Silvia Muccioli ◽  
Jacopo Marazzato ◽  
Antonella Mancinelli ◽  
Attilio Iacovoni ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Systolic Pressure ◽  
Right Ventricular Dysfunction ◽  
Right Atrial ◽  
Pulmonary Artery Systolic Pressure ◽  
Prognostic Impact ◽  
Phone Calls ◽  
The Right

Background: subclinical pulmonary and peripheral congestion is an emerging concept in heart failure, correlated with a worse prognosis. Very few studies have evaluated its prognostic impact in an outpatient setting and its relationship with right-ventricular dysfunction. The study aims to investigate subclinical congestion in chronic heart failure outpatients, exploring the close relationship between the right heart-pulmonary unit and peripheral congestion. Materials and methods: in this observational study, 104 chronic HF outpatients were enrolled. The degree of congestion and signs of elevated filling pressures of the right ventricle were evaluated by physical examination and a transthoracic ultrasound to define multiparametric right ventricular dysfunction, estimate the right atrial pressure and the pulmonary artery systolic pressure. Outcome data were obtained by scheduled visits and phone calls. Results: ultrasound signs of congestion were found in 26% of patients and, among this cohort, half of them presented as subclinical, affecting their prognosis, revealing a linear correlation between right ventricular/arterial coupling, the right-chambers size and ultrasound congestion. Right ventricular dysfunction, TAPSE/PAPS ratio, clinical and ultrasound signs of congestion have been confirmed to be useful predictors of outcome. Conclusions: subclinical congestion is widespread in the heart failure outpatient population, significantly affecting prognosis, especially when right ventricular dysfunction also occurs, suggesting a strict correlation between the heart-pulmonary unit and volume overload.

Sign in / Sign up

Export Citation Format

Share Document