Hemodynamic Determinants of Dyspnea Improvement in Acute Decompensated Heart Failure.
Circ Heart Fail. 2012 Nov 14;
Authors: Solomonica A, Burger AJ, Aronson D
BACKGROUND: -Dyspnea relief constitutes a major treatment goal and a key measure of treatment efficacy in decompensated heart failure. However, there is no data with regard to the relationship between hemodynamic measurements during treatment and dyspnea improvement. METHODS AND RESULTS: -We studied 233 patients assigned to right heart catheterization in the Vasodilation in the Management of Acute Congestive Heart Failure trial. Dyspnea (assessed using a seven-point Likert scale) and hemodynamic parameters were measured simultaneously at 15min, 30min, 1h, 2h, 3h, 6h and 24h. Dyspnea relief was defined as moderate or marked improvement. There was a time-dependent association between the reductions in pulmonary capillary wedge pressure (PCWP; 25.4, 24.6, 24.0, 23.5, 23.4, 21.5, and 19.9 mm Hg) and the percentage of patients achieving dyspnea relief (17.7%, 24.6%, 32.2%, 36.2%, 37.8%, 47.4% and 66.1%, in the respective timepoints). Multivariable logistic generalized estimating equations modeling demonstrated that reductions of both PCWP and mean pulmonary artery pressure (mPAP) were independently associated with dyspnea relief. Compared with the highest PCWP quartile, the adjusted odds ratios for dyspnea relief were 0.92 (95% CI 0.67-1.29), 1.07 (95% CI 0.75-1.55) and 1.80 (95% CI 1.22-2.65) in the 3(rd), 2(nd) and 1(st) PCWP quartile, respectively (P(trend)=0.003). Compared with the highest mPAP quartile, the adjusted odds ratios for dyspnea relief were 2.0 (95% CI 1.41-2.82), 2.23 (95% CI 1.52-3.27) and 2.98 (95% CI 1.91-4.66) in the 3(rd), 2(nd) and 1(st) mPAP quartile, respectively (P(trend)<0.0001). CONCLUSIONS: -A clinically significant improvement in dyspnea is associated with a reduction in both PCWP and mPAP.
PMID: 23152491 [PubMed - as supplied by publisher]