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Ratio of Systolic Blood Pressure to Pulmonary Capillary Wedge Pressure Ratio: A Novel Prognostic Marker in Chronic Heart Failure
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The Journal of Heart and Lung Transplantation, Vol 38, No 4S, April 2019
323 Ratio of Systolic Blood Pressure to Pulmonary Capillary Wedge Pressure Ratio: A Novel Prognostic Marker in Chronic Heart Failure N. Narang, T. Imamura, J.E. Blair, L. Holzhauser, I. Ebong, M.N. Belkin, A. Kanelidis, A. Oehler, D. Yu, T. Fujino, D. Nitta, B. Chung, A. Nguyen, B. A. Smith, J. Raikhelkar, N. Sarswat, G.H. Kim, V. Jeevanandam, G. Sayer and N. Uriel. University of Chicago Medical Center, Chicago, IL. Purpose: Mortality from acute decompensated heart failure (DHF) remains high despite contemporary therapeutic interventions. Cardiogenic shock indices may be useful in risk-stratifying patients at highest risk for death, need for heart transplantation or durable mechanical support. The aim of this study was to compare a novel hemodynamic parameter, systolic blood pressure/pulmonary capillary wedge pressure (SBP/PCWP), to cardiac power output (CPO) in patients presenting with DHF. Methods: In this retrospective analysis, CPO (Watts; mean arterial pressure x cardiac output/451) and SBP/PCWP were calculated in those with chronic heart failure presenting with DHF, who received right heart catheterization at index admission. Hemodynamic parameter cutpoints were derived from a receiver operator curve analysis; a combined endpoint of one-year freedom from death, need for heart transplant or LVAD was compared for presence or absence of one or both hemodynamic parameters. Results: Among 128 patients (median age 60 years, 75% male), mortality at one-year was 36.7% (n=48). 38 (29.7%) were discharged with medical therapy, 14 (10.9%) underwent heart transplantation, 29 (22.7%) underwent LVAD implant. CPO < 0.65 W (Hazard Ratio 2.3, 95% Confidence Interval 1.5-3.5, p<0.001) and SBP/PCWP < 3.9 (Hazard Ratio 2.3; 95% Confidence Interval 1.5-3.6, p<0.001) were both comparable risk predictors and significantly associated with increased one-year mortality/need for transplant or LVAD by univariate logistic regression. The combination of both indices identified the patients at the highest risk of the combined outcome (Figure). Conclusion: SBP/PCWP ratio is a novel hemodynamic parameter that is comparable to CPO in predicting mortality and need for advanced heart failure therapies. In combination with CPO, this marker identifies patients who may require rapid escalation of care.
hemodynamics may contribute to impaired renal function but this relationship is not well defined. We studied the association between invasive hemodynamic measurements and glomerular filtration rate (GFR) in patients undergoing evaluation for heart transplantation (HTx). Methods: A total of 220 consecutive patients undergoing evaluation for HTx (mean age 48,6 years § SD 12,9 years; 73,6 % male) at Sahlgrenska University Hospital during 1988 and 2018 were included in the study. Patients underwent right sided cardiac catheterization with measurements of central hemodynamics and GFR was measured with 51chrome-EDTA clearance. Results: GFR showed a significant positive correlation with mean arterial pressure (MAP), heart rate (HR) and mixed venous oxygen saturation (SvO 2 ) and a significant negative correlation with right atrial pressure (RAP); but no correlation with pulmonary artery wedge pressure (PCWP) or cardiac output (CO). In a stepwise multivariate regression analysis adjusted for age and sex, GFR was independently associated with MAP (b-estimate 0.27; p= 0.017), RAP (b-estimate -0.55; p= 0.018), and tended to be related to HR (b-estimate 0.13; p= 0.061). Conclusion: Impaired GFR in patients with advanced HF is independently related to decreasing MAP and increasing RAP, probably reflecting a poor renal perfusion pressure.
325 Use of Remote Dielectric Sensing (ReDS) as Point-of-Care Testing Following Heart Failure Hospitalization and Risk of 30-Day Readmission M.H. Barghash,1 A. Lala,1 G. Giustino,1 A. Parikh,1 J. Ullman,1 S.S. Mitter,1 S. Konje,2 B. Keith,1 N. Moss,1 D. Mancini,1 M.G. Trivieri,1 J. Contreras,1 D. Burkhoff,3 and S.P. Pinney.1 1The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, NY; 2 Department of Medicine, Mount Sinai Hospital, New York, NY; and the 3 Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY. 324 Association between Central Hemodynamics and Glomerular Filtration Rate in Patients with Advanced Heart Failure E. Bobbio,1 S. Esmaily,2 E. Bollano,3 S. Bartfay,3 P. Dahlberg,3 G. Dellgren,4 and K. Karason.3 1Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenbug, Sweden; 2Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 3Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; and the 4Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden. Purpose: The cardiorenal syndrome is common in patients with advanced heart failure (HF). It has been suggested that deteriorating central
Purpose: Readmission after hospitalization for heart failure (HF) remains a major public health problem. We hypothesized that point-of-care (POC) testing using remote dielectric sensing (ReDS) to measure percent lung water volume after HF hospitalization may improve guideline-directed medical therapy (GDMT) and reduce 30-day hospital readmission. Methods: Data were collected for patients scheduled for rapid follow-up (RFU) visits within 10 days post-discharge for HF at Mount Sinai Hospital between July 1, 2017 and July 21, 2018 and included whether ReDS readings were obtained and medication changes were made. Diuretics were adjusted using the following algorithm: hold diuretics if ReDS < 20%; maintain diuretic dose and optimize GDMT if ReDS 21 to 35%; increase diuretics if ReDS 36 to 45% with 1 week RFU; IV loop diuretic or hospitalization if ReDS > 46%. The association between use of ReDS and 30-
The Journal of Heart and Lung Transplantation, Vol 38, No 4S, April 2019
323 Ratio of Systolic Blood Pressure to Pulmonary Capillary Wedge Pressure Ratio: A Novel Prognostic Marker in Chronic Heart Failure N. Narang, T. Imamura, J.E. Blair, L. Holzhauser, I. Ebong, M.N. Belkin, A. Kanelidis, A. Oehler, D. Yu, T. Fujino, D. Nitta, B. Chung, A. Nguyen, B. A. Smith, J. Raikhelkar, N. Sarswat, G.H. Kim, V. Jeevanandam, G. Sayer and N. Uriel. University of Chicago Medical Center, Chicago, IL. Purpose: Mortality from acute decompensated heart failure (DHF) remains high despite contemporary therapeutic interventions. Cardiogenic shock indices may be useful in risk-stratifying patients at highest risk for death, need for heart transplantation or durable mechanical support. The aim of this study was to compare a novel hemodynamic parameter, systolic blood pressure/pulmonary capillary wedge pressure (SBP/PCWP), to cardiac power output (CPO) in patients presenting with DHF. Methods: In this retrospective analysis, CPO (Watts; mean arterial pressure x cardiac output/451) and SBP/PCWP were calculated in those with chronic heart failure presenting with DHF, who received right heart catheterization at index admission. Hemodynamic parameter cutpoints were derived from a receiver operator curve analysis; a combined endpoint of one-year freedom from death, need for heart transplant or LVAD was compared for presence or absence of one or both hemodynamic parameters. Results: Among 128 patients (median age 60 years, 75% male), mortality at one-year was 36.7% (n=48). 38 (29.7%) were discharged with medical therapy, 14 (10.9%) underwent heart transplantation, 29 (22.7%) underwent LVAD implant. CPO < 0.65 W (Hazard Ratio 2.3, 95% Confidence Interval 1.5-3.5, p<0.001) and SBP/PCWP < 3.9 (Hazard Ratio 2.3; 95% Confidence Interval 1.5-3.6, p<0.001) were both comparable risk predictors and significantly associated with increased one-year mortality/need for transplant or LVAD by univariate logistic regression. The combination of both indices identified the patients at the highest risk of the combined outcome (Figure). Conclusion: SBP/PCWP ratio is a novel hemodynamic parameter that is comparable to CPO in predicting mortality and need for advanced heart failure therapies. In combination with CPO, this marker identifies patients who may require rapid escalation of care.
hemodynamics may contribute to impaired renal function but this relationship is not well defined. We studied the association between invasive hemodynamic measurements and glomerular filtration rate (GFR) in patients undergoing evaluation for heart transplantation (HTx). Methods: A total of 220 consecutive patients undergoing evaluation for HTx (mean age 48,6 years § SD 12,9 years; 73,6 % male) at Sahlgrenska University Hospital during 1988 and 2018 were included in the study. Patients underwent right sided cardiac catheterization with measurements of central hemodynamics and GFR was measured with 51chrome-EDTA clearance. Results: GFR showed a significant positive correlation with mean arterial pressure (MAP), heart rate (HR) and mixed venous oxygen saturation (SvO 2 ) and a significant negative correlation with right atrial pressure (RAP); but no correlation with pulmonary artery wedge pressure (PCWP) or cardiac output (CO). In a stepwise multivariate regression analysis adjusted for age and sex, GFR was independently associated with MAP (b-estimate 0.27; p= 0.017), RAP (b-estimate -0.55; p= 0.018), and tended to be related to HR (b-estimate 0.13; p= 0.061). Conclusion: Impaired GFR in patients with advanced HF is independently related to decreasing MAP and increasing RAP, probably reflecting a poor renal perfusion pressure.
325 Use of Remote Dielectric Sensing (ReDS) as Point-of-Care Testing Following Heart Failure Hospitalization and Risk of 30-Day Readmission M.H. Barghash,1 A. Lala,1 G. Giustino,1 A. Parikh,1 J. Ullman,1 S.S. Mitter,1 S. Konje,2 B. Keith,1 N. Moss,1 D. Mancini,1 M.G. Trivieri,1 J. Contreras,1 D. Burkhoff,3 and S.P. Pinney.1 1The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, NY; 2 Department of Medicine, Mount Sinai Hospital, New York, NY; and the 3 Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY. 324 Association between Central Hemodynamics and Glomerular Filtration Rate in Patients with Advanced Heart Failure E. Bobbio,1 S. Esmaily,2 E. Bollano,3 S. Bartfay,3 P. Dahlberg,3 G. Dellgren,4 and K. Karason.3 1Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenbug, Sweden; 2Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 3Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; and the 4Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden. Purpose: The cardiorenal syndrome is common in patients with advanced heart failure (HF). It has been suggested that deteriorating central
Purpose: Readmission after hospitalization for heart failure (HF) remains a major public health problem. We hypothesized that point-of-care (POC) testing using remote dielectric sensing (ReDS) to measure percent lung water volume after HF hospitalization may improve guideline-directed medical therapy (GDMT) and reduce 30-day hospital readmission. Methods: Data were collected for patients scheduled for rapid follow-up (RFU) visits within 10 days post-discharge for HF at Mount Sinai Hospital between July 1, 2017 and July 21, 2018 and included whether ReDS readings were obtained and medication changes were made. Diuretics were adjusted using the following algorithm: hold diuretics if ReDS < 20%; maintain diuretic dose and optimize GDMT if ReDS 21 to 35%; increase diuretics if ReDS 36 to 45% with 1 week RFU; IV loop diuretic or hospitalization if ReDS > 46%. The association between use of ReDS and 30-