Document Detail

Chronic ambulatory intracardiac pressures and future heart failure events.
MedLine Citation:
PMID:  20562255     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Intracardiac pressures in heart failure (HF) have been measured in patients while supine in the hospital but change at home with posture and activity. The optimal level of chronic ambulatory pressure is unknown. This analysis compared chronic intracardiac pressures to later HF events and sought a threshold above which higher pressures conferred worse outcomes.
METHODS AND RESULTS: Median pressures were measured every 24 hours from continuous 8-minute segments for 6 months after implantation of hemodynamic monitors in 261 patients with New York Heart Association class III-IV HF in the Chronicle Offers Management to Patients with Advanced Signs and Symptoms of Heart Failure Study. Baseline and chronic daily medians of estimated pulmonary artery diastolic, right ventricular systolic, and right ventricular end-diastolic pressures were compared with HF event rate. The group median for chronic 24-hour estimated pulmonary artery diastolic pressure was 28 mm Hg (excluding 7 days before and after events). Despite weight-guided management, events occurred in 100 of 261 (38%) patients. Event risk increased progressively with higher chronic 24-hour estimated pulmonary artery diastolic pressure, from 20% at 18 mm Hg to 34% at 25 mm Hg and 56% at 30 mm Hg, with similar relations for right ventricular pressures. Among patients with baseline day median estimated pulmonary artery diastolic pressures of ≥25 mm Hg, event risk was 1.10/6 mo when they remained chronically ≥25 mm Hg, but risk fell to 0.47 when 24-hour pressures declined to <25 mm Hg for more than half of the days.
CONCLUSIONS: Despite current management, many patients with advanced HF live on a plateau of high filling pressures from which later events occur. This risk is progressively higher with higher chronic ambulatory pressures. It is not known whether more targeted intervention could maintain lower chronic ambulatory pressures and better outcomes.
Lynne Warner Stevenson; Michael Zile; Tom D Bennett; Fred J Kueffer; Mariell L Jessup; Philip Adamson; William T Abraham; Ven Manda; Robert C Bourge
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-06-18
Journal Detail:
Title:  Circulation. Heart failure     Volume:  3     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-15     Completed Date:  2010-10-14     Revised Date:  2011-10-27    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  580-7     Citation Subset:  IM    
Advanced Heart Disease Section, Brigham and Women's Hospital, Boston, Mass 02115, USA.
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MeSH Terms
Blood Pressure Monitoring, Ambulatory / methods*
Heart Failure / physiopathology*
Middle Aged
Predictive Value of Tests
Proportional Hazards Models
Pulmonary Artery / physiopathology
Survival Rate
Ventricular Pressure / physiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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