Shiro Ishihara1,2, Etienne Gayat2,3,4, Naoki Sato1, Mattia Arrigo2,4,5, Said Laribi2,3,6, Matthieu Legrand2,3,4, Rui Placido2,7, Philippe Manivet2,8,9, Alain Cohen-Solal2,3,10, William T Abraham11, Mariell Jessup12, Alexandre Mebazaa13,14,15. 1. Cardiology Department, Steel Memorial Yawata Hospital, Kitakyushu, Japan. 2. Inserm UMR-S 942, Paris, France. 3. University Paris Diderot, Sorbonne Paris Cité, Paris, France. 4. Department of Anesthesia and Critical Medicine, Hôpitaux Universitaires Saint Louis-Lariboisière, AP-HP, 2 Rue Ambroise Paré, 75010, Paris, France. 5. Division of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland. 6. Department of Emergency Medicine, Hôpitaux Universitaires Saint Louis-Lariboisière, AP-HP, Paris, France. 7. Hospital Santa Maria, Serv Cardiologia I, Lisbon Academic Medical Centre, CCUL, Lisbon, Portugal. 8. Department of Biochemistry, Lariboisière Hospital, 2, Rue A. Paré, 75475, Paris Cedex 10, France. 9. France Center for Biological Resources, Lariboisière Hospital, Paris, France. 10. Department of Cardiology, Hôpitaux Universitaires Saint Louis-Lariboisière, Paris, France. 11. Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA. 12. The Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA. 13. Inserm UMR-S 942, Paris, France. alexandre.mebazaa@aphp.fr. 14. University Paris Diderot, Sorbonne Paris Cité, Paris, France. alexandre.mebazaa@aphp.fr. 15. Department of Anesthesia and Critical Medicine, Hôpitaux Universitaires Saint Louis-Lariboisière, AP-HP, 2 Rue Ambroise Paré, 75010, Paris, France. alexandre.mebazaa@aphp.fr.
Abstract
BACKGROUND: Acute heart failure (AHF) with reduced left-ventricular ejection fraction (LVEF) is often a biventricular congested state. The comparative effect of vasodilators and inotropes on the right- and/or left-sided congestion is unknown. METHODS AND RESULTS: A systematic review, meta-analysis, and meta-regression of AHF studies using pulmonary artery catheter were performed using PubMed, Embase, and Cochrane library. Data from 35 studies, including 3016 patients, were studied. Included patients had a weighted mean age of 60 years, left-ventricular ejection fraction (LVEF) of 24 %, and plasma B-type natriuretic peptide (BNP) of 892 pg/ml. Both the left- and right-ventricular filling pressures were elevated: weighted mean pulmonary artery wedge pressure (PAWP) was 25 mmHg (range 17-31 mmHg) and right atrial pressure (RAP) 12 mmHg (range 7-18 mmHg). Vasodilators and inotropes had similar beneficial effects on PAWP [-6.3 mmHg (95 % CI -7.4 to -5.2 mmHg) and -5.8 mmHg (95 % CI -7.6 to -4.0 mmHg), respectively] and RAP [-2.9 mmHg (95 % CI -3.8 to -2.1 mmHg) and -2.8 mmHg (95 % CI -3.8 to -1.7 mmHg), respectively]. Among inotropes, inodilators, such as levosimendan, have greater beneficial effect on the left-ventricular filling pressure than dobutamine. Drug-induced improvement of PAWP tightly paralleled that of RAP with all studied drugs (r 2 = 0.90, p < 0.001). Vasodilators and inotropes had no short-term effect of renal function. CONCLUSION: The left- and right-sided filling pressures are similarly improved by vasodilators or inotropes, in AHF with reduced LVEF.
BACKGROUND: Acute heart failure (AHF) with reduced left-ventricular ejection fraction (LVEF) is often a biventricular congested state. The comparative effect of vasodilators and inotropes on the right- and/or left-sided congestion is unknown. METHODS AND RESULTS: A systematic review, meta-analysis, and meta-regression of AHF studies using pulmonary artery catheter were performed using PubMed, Embase, and Cochrane library. Data from 35 studies, including 3016 patients, were studied. Included patients had a weighted mean age of 60 years, left-ventricular ejection fraction (LVEF) of 24 %, and plasma B-type natriuretic peptide (BNP) of 892 pg/ml. Both the left- and right-ventricular filling pressures were elevated: weighted mean pulmonary artery wedge pressure (PAWP) was 25 mmHg (range 17-31 mmHg) and right atrial pressure (RAP) 12 mmHg (range 7-18 mmHg). Vasodilators and inotropes had similar beneficial effects on PAWP [-6.3 mmHg (95 % CI -7.4 to -5.2 mmHg) and -5.8 mmHg (95 % CI -7.6 to -4.0 mmHg), respectively] and RAP [-2.9 mmHg (95 % CI -3.8 to -2.1 mmHg) and -2.8 mmHg (95 % CI -3.8 to -1.7 mmHg), respectively]. Among inotropes, inodilators, such as levosimendan, have greater beneficial effect on the left-ventricular filling pressure than dobutamine. Drug-induced improvement of PAWP tightly paralleled that of RAP with all studied drugs (r 2 = 0.90, p < 0.001). Vasodilators and inotropes had no short-term effect of renal function. CONCLUSION: The left- and right-sided filling pressures are similarly improved by vasodilators or inotropes, in AHF with reduced LVEF.
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