scholarly journals Pulmonary Artery Pulsatility Index As A Predictor Of Cardiac Mortality In Advanced Chronic Heart Failure: Is It Beyond Right Atrial Pressure?

2020 ◽  
pp. 304-311
Author(s):  
Ali DOĞAN
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Pulmonary Artery ◽  
Pulsatility Index ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Cardiac Mortality

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).

The Haemodynamic Consequences of Acutely Raising Right Atrial Pressure in Chronic Heart Failure

1988 ◽  
Vol 75 (s19) ◽  
pp. 24P-24P
Author(s):  
RJI Bain ◽  
LB Tan ◽  
MK Davies ◽  
RG Murray ◽  
WA Littler
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure

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.

Cerebral Pulsatility Index Is Elevated in Patients with Elevated Right Atrial Pressure

2017 ◽  
Vol 28 (1) ◽  
pp. 95-98 ◽  
Author(s):  
Shouri Lahiri ◽  
Konrad H. Schlick ◽  
Matthew M. Padrick ◽  
Brenda Rinsky ◽  
Nestor Gonzalez ◽  
...  
Keyword(s):  
Pulsatility Index ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure

scholarly journals Echocardiographic RV-E/e’ for predicting right atrial pressure: a review

2020 ◽  
Author(s):  
Andrew John Fletcher ◽  
Shaun Robinson ◽  
Bushra Rana
Keyword(s):  
Heart Failure ◽  
Clinical Decision Making ◽  
Prognostic Significance ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Future Research ◽  
Accurate Estimation ◽  
Diagnostic Ability ◽  
Wide Range

Right atrial pressure (RAP) is a key cardiac parameter of diagnostic and prognostic significance, yet current two-dimensional echocardiographic methods are inadequate for the accurate estimation of this haemodynamic marker. Right-heart trans-tricuspid Doppler and tissue Doppler echocardiographic techniques can be combined to calculate the right ventricular (RV) E/e’ ratio – a reflection of RV filling pressure which is a surrogate of RAP. A systematic search was undertaken which found seventeen articles that compared invasively measured RAP with RV-E/e’ estimated RAP. Results commonly concerned pulmonary hypertension or advanced heart failure/transplantation populations. Reported receiver operator characteristic analyses showed reasonable diagnostic ability of RV-E/e’ for estimating RAP in patients with coronary artery disease and RV systolic dysfunction. The diagnostic ability of RV-E/e’ was generally poor in studies of paediatrics, heart failure and mitral stenosis, whilst results were equivocal in other diseases. Bland-Altman analyses showed good accuracy but poor precision of RV-E/e’ for estimating RAP, but were limited by only being reported in seven out of seventeen articles. This suggests that RV-E/e’ may be useful at a population level but not at an individual level for clinical decision making. Very little evidence was found about how atrial fibrillation may affect the estimation of RAP from RV-E/e’, nor about the independent prognostic ability of RV-E/e’ . Recommended areas for future research concerning RV-E/e’ include; non-sinus rhythm, valvular heart disease, short and long term prognostic ability, and validation over a wide range of RAP.

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