Clinical TrialsClinical Impact of Changes in Hemodynamic Indices of Contractile Function During Treatment of Acute Decompensated Heart Failure
Section snippets
Methods
The ESCAPE trial was a National Heart, Lung, and Blood Institute–sponsored multicenter trial conducted at 26 sites from 2000 to 2003. A total of 433 patients were randomized to receive therapy guided by clinical assessment alone or by clinical assessment and data from a pulmonary artery catheter. Of the 215 patients randomized to pulmonary artery catheter, 175 (81.4%) had complete hemodynamic and follow-up data at 6 months and were included in the present analysis. Hemodynamic measurements from
Results
The database of the ESCAPE trial contains records for 433 patients. Of these, 215 were assigned to pulmonary artery catheter–guided therapy in addition to clinical assessment. A total of 175 patients had complete invasive hemodynamics at baseline and follow-up and were included in the present analysis. The median age of patients was 56.7 ± 13.6 years old, 29.1% of the patients were female, and 59.4% had race reported as “white.” Table 1 presents the baseline characteristics of the study
Discussion
The present analysis investigated the relationship between changes in hemodynamic indexes of contractile function during pulmonary artery catheter–guided therapy in ADHF and the clinical outcomes at 6 months with the use of the ESCAPE trial database. We report 2 main findings. First, we found that increasing change in RVSWI from baseline to pulmonary artery catheter removal was associated with improved outcomes independently from the change in LVSWI. This significant interaction between the
Study Limitations
The results of this study are based on a retrospective analysis of a relatively small number of patients; therefore, further confirmatory studies are indicated based on a prospective evaluation of a larger group of patients with ADHF. In addition, the limitations of our study are tied to the inherent limitations of the ESCAPE trial design, such as the need for more precisely defined treatment strategies in response to the hemodynamic information obtained. There was also considerable variation
Conclusion
Compared with increasing LV stroke work, increasing RV stroke work during treatment of ADHF has a stronger association with improved clinical outcomes after discharge. Our results promise to inform optimal hemodynamic targets for the treatment of decompensated heart failure in the modern era.
Disclosures
None.
References (20)
- et al.
The clinical profile of patients with suspected cardiogenic shock due to predominant left ventricular failure: a report from the SHOCK trial registry. Should we emergently revascularize occluded coronaries in cardiogenic shock?
J Am Coll Cardiol
(2000) - et al.
Assessing risk by hemodynamic profile in patients awaiting cardiac transplantation
Am J Cardiol
(1994) - et al.
Clinical and hemodynamic predictors of survival in patients aged <65 years with severe congestive heart failure secondary to ischemic or nonischemic dilated cardiomyopathy
Am J Cardiol
(1993) - et al.
A community-wide assessment of the use of pulmonary artery catheters in patients with acute myocardial infarction
Chest
(1987) - et al.
Use of pulmonary artery catheters in patients with acute myocardial infarction. Analysis of experience in 5,841 patients in the SPRINT registry
Chest
(1990) - et al.
Echocardiography criteria for structural heart disease in patients with end-stage renal disease initiating hemodialysis
J Am Coll Cardiol
(2016) - et al.
Influence of chronic renal failure on cardiac structure
J Am Coll Cardiol
(2016) - et al.
Risk score derived from pre-operative data analysis predicts the need for biventricular mechanical circulatory support
J Heart Lung Transplant
(2008) - et al.
Preoperative risk factors for right ventricular failure after implantable left ventricular assist device insertion
Ann Thorac Surg
(1999) - et al.
Response of the right ventricle to exercise in patients with chronic heart disease
Am Heart J
(1983)
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Funding: Dr. Bilchick is supported by the National Institutes of Health (R03 HL135463).
This paper was handled by a Guest Editor for all reviewing stages and final decision process.