Hemodynamic Responses to Rapid Saline Loading: The Impact of Age, Sex, and Heart Failure.
Circulation. 2012 Nov 21;
Authors: Fujimoto N, Borlaug BA, Lewis GD, Hastings JL, Shafer KM, Bhella PS, Carrick-Ranson G, Levine BD
BACKGROUND: Hemodynamic assessment after volume challenge has been proposed as a way to identify heart failure with preserved ejection fraction (HFpEF). However, the normal hemodynamic response to a volume challenge and how age and sex affect this relationship remains unknown. METHODS AND RESULTS: Sixty healthy subjects underwent right heart catheterization to measure age- and sex-related normative responses of pulmonary capillary wedge pressure (PCWP) and mean pulmonary arterial pressure (MPAP) to volume loading with rapid saline infusion (100-200 ml/min). Hemodynamic responses to saline infusion in HFpEF (n=11) were then compared to healthy young (<50yrs) and older-aged (?50yrs) subjects. In healthy subjects, PCWP increased from 10±2 to 16±3 mmHg after ~1L and to 20±3 mmHg after ~2L of saline infusion. Older women displayed a steeper increase in PCWP relative to volume infused (16±4mmHg·L(-1)·m(2)) than the other 3 groups (p?0.019). Saline infusion resulted in a greater increase in MPAP relative to cardiac output in women compared to men, irrespective of age. Subjects with HFpEF exhibited a steeper increase in PCWP relative to infused volume (25±12 mmHg·L(-17)·m(2)) than healthy young and older subjects (p?0.005). CONCLUSIONS: Filling pressures rise significantly with volume loading, even in normal volunteers. Older women and patients with HFpEF exhibit the largest increases in PCWP and MPAP.
PMID: 23172838 [PubMed - as supplied by publisher]