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Dyspnea relief constitutes a major treatment goal and a key measure of treatment efficacy in decompensated heart failure (DHF). However, there is no data with regard to the relationship between hemodynamic measurements during treatment and dyspnea relief.
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 seven-point Likert scale) and hemodynamic parameters were measured simultaneously at 15min, 30min, 1h, 2h, 3h, 6h and 24h. 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 timepoints). Multivariable logistic generalized estimating equations modeling demonstrated that reductions of both PCWP and mean pulmonary artery pressure (mPAP) were independently associated with dyspnea relief. The figureshows Spline function graph of the relationship between absolute PCWP (A), PCWP change (B), absolute mPAP (C), mPAP change (D) and the probability of dyspnea relief during the first 24h.
A clinically significant improvement in dyspnea is dependent on the ability to reduce both PCWP and mPAP. Pulmonary hypertension may contribute to rest dyspnea in DHF.
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Acute Decompensated Heart Failure: Insights into Prognosis and Outcomes
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1172M-270
- 2013 American College of Cardiology Foundation