| Hemodynamic response to intensive unloading therapy (furosemide and nitroprusside) in patients >70 years of age with left ventricular systolic dysfunction and decompensated chronic heart failure. | |
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MedLine Citation:
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PMID: 14583355 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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In patients with decompensated chronic congestive heart failure (CHF), intensive unloading therapy allows an acute decrease in ventricular filling pressures and improves long-term prognosis. Because elderly patients do not routinely undergo invasive hemodynamic evaluation, they are generally denied such a pharmacologic approach. We prospectively characterized the acute hemodynamic response to intensive unloading and its prognostic significance in a elderly population with CHF who were hospitalized for cardiac decompensation. Fifty-nine patients aged >70 years with left ventricular systolic dysfunction underwent intensive unloading therapy (furosemide and nitroprusside) tailored to reduce ventricular filling pressures to near-normal levels. The hemodynamic parameters were monitored by Doppler echocardiography. At baseline, left and right ventricular filling pressures were 21 +/- 3 and 10 +/- 3 mm Hg, respectively. Although all patients experienced a relevant improvement in clinical status during hospital stay, a significant reduction of ventricular filling pressures was detected at discharge in only 40 of them (68%) (responders), whereas 19 patients (32%) had a deficient response to therapy (nonresponders). This unfavorable behavior was predicted by the presence of renal dysfunction at admission. During 19-month follow-up, death due to cardiovascular causes occurred in 8 of 40 responders (20%) and in 9 of 19 nonresponders (47%) (p <0.005). Hospitalizations for cardiovascular causes were more frequent in the nonresponders (58% vs 8%, p <0.0001). Thus, a deficient hemodynamic response to intensive unloading treatment is not infrequent in elderly patients with decompensated CHF. This behavior is predicted by renal dysfunction at admission and is associated with poorer outcome. |
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Authors:
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Giovanni Cioffi; Carlo Stefenelli; Luigi Tarantini; Cristina Opasich |
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Publication Detail:
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Type: Clinical Trial; Journal Article |
Journal Detail:
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Title: The American journal of cardiology Volume: 92 ISSN: 0002-9149 ISO Abbreviation: Am. J. Cardiol. Publication Date: 2003 Nov |
Date Detail:
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Created Date: 2003-10-29 Completed Date: 2003-12-02 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1050-6 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiology, Villa Bianca Hospital, Trento, Italy. gcioffi@albaclick.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Age Factors Aged Aged, 80 and over Female Furosemide / pharmacology*, therapeutic use Heart Failure / drug therapy*, etiology, physiopathology Hemodynamics / drug effects*, physiology Humans Male Nitroprusside / pharmacology*, therapeutic use Prognosis Prospective Studies Vasodilator Agents / pharmacology*, therapeutic use Ventricular Dysfunction, Left / complications, drug therapy*, physiopathology |
| Chemical | |
Reg. No./Substance:
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0/Vasodilator Agents; 15078-28-1/Nitroprusside; 54-31-9/Furosemide |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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