Cardiac Efficiency Improvement after Slow Continuous Ultrafiltration Is Assessed by Beat-to-Beat Minimally Invasive Monitoring in Congestive Heart Failure Patients: A Preliminary Report

Abstract

Background: We have evaluate the effect of slow continuous ultrafiltration (SCUF) on cardiac output (CO) and other hemodynamic parameters related to the overall performance of the cardiovascular system in patients with congestive heart failure (CHF). Minimally invasive hemodynamic monitoring was performed via the radial artery using a pressure recording analytical method (PRAM) during SCUF treatment. Patients and Methods: Using PRAM, hemodynamic changes were assessed in 15 CHF patients (New York Heart Association (NYHA) class III–IV) treated with fluid overload removal by ultrafiltration. We analyzed the clinical and hemodynamic data recorded from 6 h before to 36 h after SCUF treatment. Results: Fluid removal was associated with clinical improvements, reductions in weight (7.4%, p < 0.01), edema and dyspnea, increased response to diuretics, and reductions in NYHA class (3.5 ± 0.52 to 2.4 ± 0.63, p < 0.01) and plasma pro-B-type natriuretic peptide (BNP) levels (21,810 ± 13,016 to 8,581 ± 5,549 pg/ml, p < 0.05). Clinical improvement was associated with significant variations in stroke volume (+17%, p < 0.05), CO (+19%, p < 0.05), cardiac power output (+19%, p < 0.05), dP/dt_max (+49%, p < 0.01), cardiac cycle efficiency (CCE; +0.44 units, p < 0.01), systemic vascular resistances (SVR; –12%, p < 0.05) and dicrotic pressure (–10%, p < 0.05) with respect to their baseline values. No significant variations in heart rate, and systolic and mean blood pressure were observed. Pro-BNP levels were found to correlate positively with both SVR (r = 0.96, p = 0.002) and NYHA class (r = 0.96, p = 0.037) and negatively with dP/dt_max (r = –0.83, p = 0.039), CCE (r = –0.93, p = 0.011) and CO (r = –0.94, p = 0.014). Conclusions: In CHF patients, ultrafiltration improves not only CO, as previously reported, but also contractile cardiac efficiency and performance. The PRAM system, a minimally invasive method, was able to record hemodynamic changes during SCUF treatment.

Current and future role of ultrafiltration in CRS

“…In CHF patients, ultrafiltration improves not only CO, as previously reported, but also contractile cardiac efficiency and performance [26].…”

N-Terminal Pro-Brain Natriuretic Peptide as a Predictor of Heart Failure with Preserved Ejection Fraction in Hemodialysis Patients without Fluid Overload

“…Numerous studies demonstrated a close association between BNP or NT-pro BNP levels and LV mass, systolic function, and fluid status in the ESRD population [15,16,17,18], but only very few studies examined the diagnostic and prognostic potential of BNP or NT-pro BNP for HF-PEF in patients on chronic maintenance HD [3,19]. …”

Cardiorenal Syndrome

“…The intravascular volume reduction through use of diuretics does not often portend these benefits and even tends to produce opposite effects such as activation of renin-angiotensin-aldosterone system and sympathetic nervous system (21,22). The beneficial effects of UF on contractile cardiac efficiency and performance without an adverse effect on heart rate or BP were also reported by other investigators (23). In a recent randomized controlled study on patients with ADHF using a minimally invasive cardiocirculatory monitoring system, UF resulted in substantial increase in several parameters such as cardiac index and cardiac power output while simultaneously reducing systemic vascular resistance; these effects were not observed in the diuretic group (22).…”