Abstract 2560: Reduction of Filling Pressures During Hospitalization Predicts Sustained Reduction in Heart Failure Symptoms
Introduction. During hospitalization for heart failure (HF), diuresis and symptom improvement are typical, but the association between reduction in filling pressures and improvement in symptoms remains unclear. This analysis of the ESCAPE trial was designed to test the hypothesis that the extent of filling pressure reduction correlates with the degree of clinical improvement measured and described by patients.
Methods. In ESCAPE, 122 patients were identified with invasive pulmonary capillary wedge (PCW) measurements demonstrating PCW reduction after therapy adjusted to goals of PCW pressure <16 and right atrial pressure <8 mm Hg. Dyspnea during activity, 6-minute walk, patient visual analog scale of dyspnea, global assessment, and worst symptoms were obtained at baseline, discharge, and 3 months. Minnesota Living with Heart Failure (MLHF) questionnaire was completed at baseline, 1, and 3 months.
Results. Reduction of PCW was >15% in 17 patients, 15–32% in 43 patients, and >33% in 64 patients. All symptoms were improved most in those patients with the greatest reduction in PCW, both at discharge and at 3 months (Figure⇓). Six-minute walk distance increased for most patients during hospitalization, but improvement at 3 months was noted only in those patients with >15% reduction in PCW during hospitalization.
Conclusions. Early improvement in symptoms leading to HF hospitalization is closely related to reduction in PCW during therapy tailored to reduce filling pressures to near-normal levels, and this improvement is sustained at 3 months. Improvement in exercise capacity may require longer time during which decreased dyspnea allows greater activity and reconditioning.