OBJECTIVES: This study was designed to assess whether testing of potential reversibility of pulmonary hypertension (PHT) may be a useful means of defining the short-term prognosis of patients with advanced heart failure and elevated pulmonary artery pressure. In such patients, the reversibility of PHT after acute vasodilator administration is associated with a low early mortality rate after heart transplantation. However, its short-term prognostic value has not yet been determined. METHODS AND RESULTS: Between 1994 and 1998, 76 patients with advanced heart failure and PHT underwent right heart cathetherization. The hemodynamic measurements, including thermodilution-derived right ventricular ejection fraction, were repeated after an intravenous bolus of nitroglycerin (NTG). During a median follow-up period of 8.2 months (25% and 75% centiles, 3.3 and 18.9 months), 47 patients had a cardiac event (death or urgent heart transplantation). With Cox survival analysis, a multivariate model that included the New York Heart Association class and the hemodynamic variables obtained after NTG administration allowed a better assessement of the short-term prognosis of the patients than a model including the baseline variables. The evaluation of right ventricular function during the acute NTG-induced pulmonary vasodilation was of critical importance in obtaining such a refinement in the prognostic stratification. CONCLUSIONS: The prognostic evaluation of patients with advanced heart failure and PHT should include the assessment of the changes of right ventricular ejection fraction after acute afterload reduction.
OBJECTIVES: This study was designed to assess whether testing of potential reversibility of pulmonary hypertension (PHT) may be a useful means of defining the short-term prognosis of patients with advanced heart failure and elevated pulmonary artery pressure. In such patients, the reversibility of PHT after acute vasodilator administration is associated with a low early mortality rate after heart transplantation. However, its short-term prognostic value has not yet been determined. METHODS AND RESULTS: Between 1994 and 1998, 76 patients with advanced heart failure and PHT underwent right heart cathetherization. The hemodynamic measurements, including thermodilution-derived right ventricular ejection fraction, were repeated after an intravenous bolus of nitroglycerin (NTG). During a median follow-up period of 8.2 months (25% and 75% centiles, 3.3 and 18.9 months), 47 patients had a cardiac event (death or urgent heart transplantation). With Cox survival analysis, a multivariate model that included the New York Heart Association class and the hemodynamic variables obtained after NTG administration allowed a better assessement of the short-term prognosis of the patients than a model including the baseline variables. The evaluation of right ventricular function during the acute NTG-induced pulmonary vasodilation was of critical importance in obtaining such a refinement in the prognostic stratification. CONCLUSIONS: The prognostic evaluation of patients with advanced heart failure and PHT should include the assessment of the changes of right ventricular ejection fraction after acute afterload reduction.
Authors: Tomasz Kukulski; Lilin She; Normand Racine; Sinisa Gradinac; Julio A Panza; Eric J Velazquez; Kwan Chan; Mark C Petrie; Kerry L Lee; Patricia A Pellikka; Alexander Romanov; Jolanta Biernat; Jean L Rouleau; Carmen Batlle; Jan Rogowski; Paolo Ferrazzi; Marian Zembala; Jae K Oh Journal: J Thorac Cardiovasc Surg Date: 2014-10-05 Impact factor: 5.209
Authors: Grigorios Giamouzis; Xuemei Sui; Thomas E Love; Javed Butler; James B Young; Ali Ahmed Journal: Am J Cardiol Date: 2008-02-01 Impact factor: 2.778
Authors: Arantxa Barandiarán Aizpurua; Sandra Sanders-van Wijk; Hans-Peter Brunner-La Rocca; Michiel T H M Henkens; Jerremy Weerts; Mireille H A Spanjers; Christian Knackstedt; Vanessa P M van Empel Journal: ESC Heart Fail Date: 2021-01-31