Implications of the Hemodynamic Optimization Approach Guided by Right Heart Catheterization in Patients with Severe Heart Failure

Rohde, Luís Eduardo Paim; Furian, Thiago Quedi; Campos, Carla Cristian; Biolo, Andréia; Rabelo, Eneida Rejane; Foppa, Murilo; Clausell, Nadine Oliveira

doi:10.1590/s0066-782x2002000300001

Cited by 9 publications

(11 citation statements)

References 17 publications

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“…Hypervolemia subgroup patients (table III) also showed excellent benefits with the strategy used. After completion of protocol, there was a significant improvement of cardiac index (a 42.7% increase, with median varying from 1.85 ± 0.59 l/min/m 2 to 2.64 ± 0.75 l/min/m 2 ), reduction of SVRI in 40% (from 2,972 ± 1,259.3 dynes/s/cm -5 /m 2 to 1,784 ± 781.3 dynes/s/cm -5 /m 2 ), decrease of PWP in 37.7% (from 26.5 ± 8.5 mmHg to 16.5 ± 4 mmHg) and CVP in 38.4% (from 13 ± 4.5 mmHg to 8 ± (9,17,18) showed initial PWP between 20 mmHg and 15 mmHg and were considered as hypervolemic and decompensate. The same strategy for those with PWP > 20 mmHg was used, which resulted in an expressive increase of cardiac index in the three of them and a decrease in peripheral vascular resistance in the last two.…”

Section: Resultsmentioning

confidence: 95%

Terapia da insuficiência cardíaca avançada ajustada por objetivos hemodinâmicos obtidos pela monitorização invasiva

Júnior¹,

Esporcatte²,

Rangel³

et al. 2005

Arq. Bras. Cardiol.

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Section: Resultsmentioning

confidence: 95%

Terapia da insuficiência cardíaca avançada ajustada por objetivos hemodinâmicos obtidos pela monitorização invasiva

Júnior¹,

Esporcatte²,

Rangel³

et al. 2005

Arq. Bras. Cardiol.

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“…Other studies have shown that orthopnea is associated with higher left ventricular filling pressures in a population of patients referred for cardiac transplantation 5 and that orthopnea could be a good predictor of changes in pulmonary capillary wedge pressure (PCWP) in patients with heart failure 7 . Positive hepatojugular reflux also correlated well with elevated PCWP in patients with heart failure 7,8 . An abnormal arterial blood pressure response to the Valsalva maneuver predicted elevated PCWP with high sensitivity and specificity, 9,10 but its implementation is difficult at the bedside.…”

Section: Discussionmentioning

confidence: 99%

Persistent Orthopnea and the Prognosis of Patients in the Heart Failure Clinic

Beck-da-Silva

Mielniczuk

Laberge

et al. 2004

Congestive Heart Failure

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Heart failure (HF) is a public health problem with ever‐growing costs. Signs such as jugular venous pressure and third heart sound have been associated with disease prognosis. Symptoms of heart failure are frequently subjective, and their real value is often overlooked. The authors aimed to assess the relationship between orthopnea and left ventricular ejection fraction (LVEF) and hospitalization rate in patients referred to the HF clinic. One hundred fifty‐three new consecutive patients referred to the HF clinic from September 2001 to July 2002 were reviewed. Information about orthopnea was available at baseline and at a 6‐month to 1‐year follow‐up. One hundred thirty‐one patients had a baseline multigated radionuclide ventriculogram scan, and 68 patients had a follow‐up multigated radionuclide ventriculogram scan available. The patients were divided into groups by presence of orthopnea and compared with respect to LVEF and hospitalization rate. Patients with or without orthopnea had similar LVEFs at baseline (32%±17% vs. 33%±15%, respectively; p=NS). However, patients who were orthopnea‐free at the follow‐up visit had a significant LVEF improvement whereas patients with ongoing orthopnea at follow‐up had no LVEF improvement (11%±13% vs. −1%±6%; p<0.001). Patients who presented with persistent orthopnea had a significantly higher rate of hospitalization (64% vs. 15.3%; p=0.0001). Persistent orthopnea in HF patients is associated with a significantly higher rate of hospitalization and with worsening or no improvement in LVEF. Patients with persistent orthopnea may require a more aggressive approach to improve their outcome. This result may help centers with limited access to LVEF measurements to better stratify HF patients' risk.

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“…Vasodilator based therapies have not been very common in everyday practice despite a clear physiological rational for their use 33,34 . However, there are some limitations to this kind of therapy: a) ICU admission is usually required to monitor blood pressure.…”

Section: Intravenous Vasodilatorsmentioning

confidence: 99%