Role of cardiac power in heart failure

Cotter, Gad; Williams, Simon G.; Vered, Zvi; Tan, Lip Bun

doi:10.1097/00001573-200305000-00007

Cited by 153 publications

(111 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Cardiac power output, 13 defined as cardiac outputϫmean arterial pressureϫ0.0022, was calculated to account for systemic blood flow and maintenance of physiologically appropriate blood pressure during the procedural ischemic times. As determined by the maximal drop in cardiac power output from baseline, Impella 2.5 provided better hemodynamic support than IABP during these high-risk procedures (Ϫ0.04Ϯ0.24 versus Ϫ0.14Ϯ0.27 W, Pϭ0.001).…”

Section: Secondary End Points and Prespecified Subgroup Analysismentioning

confidence: 99%

A Prospective, Randomized Clinical Trial of Hemodynamic Support With Impella 2.5 Versus Intra-Aortic Balloon Pump in Patients Undergoing High-Risk Percutaneous Coronary Intervention

et al. 2012

View full text Add to dashboard Cite

Background— Although coronary artery bypass grafting is generally preferred in symptomatic patients with severe, complex multivessel, or left main disease, some patients present with clinical features that make coronary artery bypass grafting clinically unattractive. Percutaneous coronary intervention with hemodynamic support may be feasible for these patients. Currently, there is no systematic comparative evaluation of hemodynamic support devices for this indication. Methods and Results— We randomly assigned 452 symptomatic patients with complex 3-vessel disease or unprotected left main coronary artery disease and severely depressed left ventricular function to intra-aortic balloon pump (IABP) (n=226) or Impella 2.5 (n=226) support during nonemergent high-risk percutaneous coronary intervention. The primary end point was the 30-day incidence of major adverse events. A 90-day follow-up was required, as well, by protocol. Impella 2.5 provided superior hemodynamic support in comparison with IABP, with maximal decrease in cardiac power output from baseline of −0.04±0.24 W in comparison with −0.14±0.27 W for IABP ( P =0.001). The primary end point (30-day major adverse events) was not statistically different between groups: 35.1% for Impella 2.5 versus 40.1% for IABP, P =0.227 in the intent-to-treat population and 34.3% versus 42.2%, P =0.092 in the per protocol population. At 90 days, a strong trend toward decreased major adverse events was observed in Impella 2.5–supported patients in comparison with IABP: 40.6% versus 49.3%, P =0.066 in the intent-to-treat population and 40.0% versus 51.0%, P =0.023 in the per protocol population, respectively. Conclusions— The 30-day incidence of major adverse events was not different for patients with IABP or Impella 2.5 hemodynamic support. However, trends for improved outcomes were observed for Impella 2.5–supported patients at 90 days. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00562016.

show abstract

Section: Secondary End Points and Prespecified Subgroup Analysismentioning

confidence: 99%

A Prospective, Randomized Clinical Trial of Hemodynamic Support With Impella 2.5 Versus Intra-Aortic Balloon Pump in Patients Undergoing High-Risk Percutaneous Coronary Intervention

et al. 2012

View full text Add to dashboard Cite

show abstract

“…By incorporating both the pressure and flow domains of the cardiovascular system, cardiac power is an intergrated measure of the cardiac hydraulic pumping capacity and it has been argued that it provides a comprehensive indicator of cardiac function. 19 Cardiac power has been shown to be powerful predictor of mortality in patients with acute cardiac diseases including cardiogenic shock. 20 It should be noted that submaximal measures such as O 2 kinetics and ventilatory efficiency, which are not influenced by mechanical work, have been evaluated as prognostic markers.…”

Section: Lang Et Al Hemodynamic Response and Prognosis In Chfmentioning

confidence: 99%

Peak Cardiac Power Output, Measured Noninvasively, Is a Powerful Predictor of Outcome in Chronic Heart Failure

Lang

Karlin

Haythe

et al. 2009

Circ: Heart Failure

113

101

View full text Add to dashboard Cite

Background-The cardiac output (CO) response to exercise and other invasively derived hemodynamic variables has been variably described to provide better prognostication than peak VO 2 in patients with chronic heart failure. Using noninvasive measurements of CO during exercise, we compared the prognostic value of peak CO and cardiac power to peak VO 2 in chronic heart failure patients. Method and Results-One hundred seventy-one consecutive patients with chronic heart failure underwent symptom limited bicycle exercise with noninvasive estimation of CO using an inert gas rebreathing method. An accurate measure of peak CO was obtained in 148 patients (85% of patients; mean age, 53Ϯ14 years; 80% male; left ventricular ejection fraction, 24Ϯ12%; ischemic etiology, 34%). Peak cardiac power was derived from the product of the peak mean arterial blood pressure and CO divided by 451. End points consisted of death, urgent heart transplant, or left ventricular assist device implantation. Duration of follow-up averaged 337Ϯ252 days (median, 295 days). Univariate and multivariate analysis were performed. The variables analyzed included peak VO 2 , peak CO, peak cardiac power, VE/VCO 2 slope, and VO 2 at anaerobic threshold. Event-free survival for the entire cohort was 83% with 5 deaths, 4 left ventricular assist device implants, and 16 urgent transplants. Peak VO 2 was 12.9Ϯ4.5 mL/kg per min, and peak cardiac power was 1.7Ϯ0.9 W. Peak VO 2 , peak CO, peak cardiac power, VE/VCO 2 slope, and VO 2 at anaerobic threshold were predictive of outcome on univariate analysis. On multivariate analysis, peak cardiac power and peak CO were predictive of outcome with peak cardiac power being the most powerful independent predictor of outcome (Pϭ0.01). Conclusions-Peak cardiac power, measured noninvasively, is an independent predictor of outcome that can enhance the prognostic power of peak VO 2 in the evaluation of patients with heart failure. (Circ Heart Fail. 2009;2:33-38.)

show abstract

“…Many previous studies of cardiovascular system in GHD patients have relied upon evaluations obtained through imaging techniques [4,[28][29][30] that tend to provide information about cardiac structure and performance. This study builds on such cumulative data and provides complementary information on actual function of the organ during maximal exercise by providing the hydraulic energy necessary to maintain the circulation [17], which are pathophysiologically and clinically quite relevant in patient management.…”

Section: Discussionmentioning

confidence: 99%

“…GHD was confirmed with a peak GH < 3.7 μg/L in response to a stimulation test (mean 0.86 μg/L, range 0.0-3.4 μg/L). GHD patients had a significantly impaired quality of life (QoL), as assessed by the disease-specific QoL-AGHDA score (mean 20, range [12][13][14][15][16][17][18][19][20][21][22][23][24][25] at the time of recruitment into this study (a higher score indicating a lower self-perceived QoL). The mean IGF-1 was 11.9 nmol/L, with a range of 7.1-27.4 nmol/L.…”

Section: Subject Characteristicsmentioning

confidence: 99%

“…The majority of cardiac studies of GHD patients have employed echocardiographic or radionuclide investigations that provide useful structural information (size and volumes) and performance characteristics (e.g., ejection fraction) that are not directly indicative of how well the organ can maintain the circulation, especially during peak stress. In order to evaluate the overall cardiac organ function in modern cardiological practice, we have shown that it is crucial to measure hydraulic power-generating capacity during peak stimulation (e.g., exercise to volitional exhaustion) by employing noninvasive methods in normal subjects and cardiac patients [13][14][15], with noteworthy clinical findings [16][17][18][19]. Patients with heart failure who have, using this method of cardiovascular assessment, a reduced functional cardiac reserve have a worse prognosis and increased mortality [19].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cardiac Functional Reserve is Diminished in Growth Hormone‐Deficient Adults

Moisey¹,

Orme²,

Barker³

et al. 2009

Cardiovascular Therapeutics

View full text Add to dashboard Cite

Various studies have shown that patients with severe growth hormone deficiency (GHD) have diverse changes in left ventricular (LV) size or performance but so far there is no direct indication of cardiac reserve ability to maintain the circulation during peak exercise. We tested the hypothesis that patients with severe GHD have reduced cardiac reserve function compared with healthy controls. Eighteen patients with severe GHD were studied and compared with 18 age-, sex-, and body mass index (BMI)-matched healthy controls. Peak cardiac power and cardiorespiratory fitness were investigated using noninvasive hemodynamic measurements during maximal cardiopulmonary exercise testing. Compared with matched controls, the cardiac power of GHD patients during exercise to volitional exhaustion was significantly reduced by 15% (mean ± SD: 4.4 ± 1.0 watts (W) vs. 5.2 ± 1.0 W, P = 0.02), despite attaining similar aerobic exercise peaks (VO 2max , GHD: 2390 ± 822 mL/min vs. controls: 2461 ± 872 mL/min, P = 0.80) and similar peak respiratory exchange ratios. The lower peak cardiac power could not be accounted for by peripheral alterations because both groups reached similar peak exercise systemic vascular resistances. Patients with GHD also had lower cardiac chronotropic reserve (peak heart rate: 154 ± 21 bpm vs. 174 ± 11 bpm, P = 0.001) and a lower cardiac pressure-generating capacity (systolic blood pressure [SBP] 160 ± 25 mmHg vs. 200 ± 15 mmHg, P < 0.0001). Using this robust noninvasive method of assessing functional cardiac pumping capacity we have for the first time shown that patients with severe GHD have a significantly impaired cardiac functional reserve associated with chronotropic incompetence and impaired pressure-generating capacity.

show abstract

Role of cardiac power in heart failure

Cited by 153 publications

References 42 publications

A Prospective, Randomized Clinical Trial of Hemodynamic Support With Impella 2.5 Versus Intra-Aortic Balloon Pump in Patients Undergoing High-Risk Percutaneous Coronary Intervention

A Prospective, Randomized Clinical Trial of Hemodynamic Support With Impella 2.5 Versus Intra-Aortic Balloon Pump in Patients Undergoing High-Risk Percutaneous Coronary Intervention

Peak Cardiac Power Output, Measured Noninvasively, Is a Powerful Predictor of Outcome in Chronic Heart Failure

Cardiac Functional Reserve is Diminished in Growth Hormone‐Deficient Adults

Contact Info

Product

Resources

About