Document Detail


Long-term vasodilator therapy for heart failure: clinical response and its relationship to hemodynamic measurements.
MedLine Citation:
PMID:  6778625     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
To assess the clinical efficacy of chronic vasodilator therapy for refractory congestive heart failure, the long-term follow-up (mean 13 months, range 3-30 months) was evaluated in 56 patients treated with hydralazine, usually in combination with nitrates. In the first 6 months, 73% improved subjectively and 59% improved by one or two New York Heart Association classifications; early improvement was usually sustained. Mortality was high, 22% at 6 months and 37% at 12 months, but was significantly lower in patients who had a clinical response to vasodilators (21% in responders vs 55% in nonresponders at 1 year). The only clinical indicator that differentiated responders from nonresponders was the presence or absence of symptomatic progression before initiation of vasodilator therapy. Pulmonary artery pressure, pulmonary capillary wedge (PCW) pressure and stroke work index (SWI) before and during vasodilator therapy correlated with clinical response and survival. Fifteen of 20 patients with PCW < 20 mm Hg and SWI greater than or equal to 30 g-m/m2 improved and survived, compared with two of 19 with PCS greater than or equal to 20 mm Hg and SWI < 30 g-m/m2. Patients who did not have acute hemodynamic improvement generally did not improve clinically, but neither the percentage change nor the absolute change in any hemodynamic variable predicted outcome in the remaining patients. The findings of this study indicate that vasodilators produce clinical improvement in many patients with refractory heart failure and that hemodynamic measurements are helpful in predicting the outcome of therapy.
Authors:
B Massie; T Ports; K Chatterjee; W Parmley; J Ostland; J O'Young; F Haughom
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Circulation     Volume:  63     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1981 Feb 
Date Detail:
Created Date:  1981-03-17     Completed Date:  1981-03-17     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  269-78     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Blood Pressure / drug effects
Drug Therapy, Combination
Female
Follow-Up Studies
Heart Failure / drug therapy*,  etiology,  mortality
Heart Rate / drug effects
Hemodynamics / drug effects*
Humans
Hydralazine / adverse effects,  therapeutic use*
Long-Term Care
Male
Middle Aged
Nitrates / therapeutic use
Vasodilator Agents*
Grant Support
ID/Acronym/Agency:
HL-06285/HL/NHLBI NIH HHS; HL-07192/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Nitrates; 0/Vasodilator Agents; 86-54-4/Hydralazine

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


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