Hemodynamic determinants of dyspnea improvement in acute decompensated heart failure

Circ Heart Fail. 2013 Jan;6(1):53-60. doi: 10.1161/CIRCHEARTFAILURE.112.970335. Epub 2012 Nov 14.

Abstract

Background: Dyspnea relief constitutes a major treatment goal and a key measure of treatment efficacy in decompensated heart failure. However, there are no data with regard to the relationship between hemodynamic measurements during treatment and dyspnea improvement.

Methods and results: We studied 233 patients assigned to right heart catheterization in the Vasodilation in the Management of Acute Congestive Heart Failure trial. Dyspnea (assessed using a 7-point Likert scale) and hemodynamic parameters were measured simultaneously at 15 and 30 minutes and 1, 2, 3, 6, and 24 hours. Dyspnea relief was defined as moderate or marked improvement. There was a time-dependent association between the reductions in pulmonary capillary wedge pressure (PCWP; 25.4, 24.6, 24.0, 23.5, 23.4, 21.5, and 19.9 mm Hg) and the percentage of patients achieving dyspnea relief (17.7%, 24.6%, 32.2%, 36.2%, 37.8%, 47.4%, and 66.1%, in the respective time points). Multivariable logistic generalized estimating equations modeling demonstrated that reductions of both PCWP and mean pulmonary artery pressure were independently associated with dyspnea relief. Compared with the highest PCWP quartile, the adjusted odds ratios for dyspnea relief were 0.92 (95% confidence interval [CI], 0.67-1.29), 1.07 (95% CI, 0.75-1.55), and 1.80 (95% CI, 1.22-2.65) in the third, second, and first PCWP quartiles, respectively (P(trend)=0.003). Compared with the highest mean pulmonary artery pressure quartile, the adjusted odds ratios for dyspnea relief were 2.0 (95% CI, 1.41-2.82), 2.23 (95% CI, 1.52-3.27), and 2.98 (95% CI, 1.91-4.66) in the third, second, and first mean pulmonary artery pressure quartiles, respectively (P(trend)<0.0001).

Conclusions: A clinically significant improvement in dyspnea is associated with a reduction in both PCWP and mean pulmonary artery pressure.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Acute Disease
  • Dyspnea / drug therapy
  • Dyspnea / etiology
  • Dyspnea / physiopathology*
  • Female
  • Follow-Up Studies
  • Heart Failure / complications
  • Heart Failure / drug therapy*
  • Heart Failure / physiopathology
  • Hemodynamics*
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Agents / therapeutic use
  • Natriuretic Peptide, Brain / therapeutic use*
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Natriuretic Agents
  • Natriuretic Peptide, Brain