Document Detail


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.
MedLine Citation:
PMID:  14583355     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Giovanni Cioffi; Carlo Stefenelli; Luigi Tarantini; Cristina Opasich
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  92     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2003 Nov 
Date Detail:
Created Date:  2003-10-29     Completed Date:  2003-12-02     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1050-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Villa Bianca Hospital, Trento, Italy. gcioffi@albaclick.com
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MeSH Terms
Descriptor/Qualifier:
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:
0/Vasodilator Agents; 15078-28-1/Nitroprusside; 54-31-9/Furosemide

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