Author + information
- Sula Mazimba,
- Peter McCullough,
- Mitchell Rosner,
- Eliany Mejia-Lopez and
- Kenneth Bilchick
Background: Patients in acute decompensated heart failure (ADHF) undergoing diuretic therapy are vulnerable to worsening renal function (WRF). We hypothesized that decreases in renal perfusion pressure (RPP), the difference between mean arterial pressure and central venous pressure, would provide a direct mechanism for the development of WRF during treatment of ADHF.
Methods: Patients in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization (PAC) Effectiveness (ESCAPE) trial randomized to PAC-guided therapy were evaluated for incidence and mechanisms of WRF during therapy. Multivariable linear regression, logistic regression, and receiver operating characteristic (ROC) analysis were performed.
Results: Among 143 patients (mean age 56.7 ± 13.8 years, 26.6% female) randomized to PAC-guided therapy with complete data, 17 patients (11.9%) had more than a 30% decrease in glomerular filtration rate (GFR) during therapy, estimated using Modification of Diet in Renal Disease Equation. In a linear regression model, the percent change in GFR was linearly associated with the percent change in RPP during therapy (standardized coefficient 0.18; P=0.04). In a logistic regression model, a 30% decrease in GFR during therapy was associated with a greater likelihood of a decrease in RPP (OR 1.44 per 10 mmHg decrease in the RPP; AUC=0.64; P=0.048).
Conclusions: Changes in RPP provide mechanistic explanation for WRF in patients undergoing hemodynamically guided therapy for ADHF.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Acute Heart Failure: Evaluating Strategies to Prevent Readmissions
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1163-260
- 2017 American College of Cardiology Foundation