Abstract 13414: Hemodynamic Responses to Rapid Saline Loading: The Impact of Age, Sex, and Heart Failure
Background: Hemodynamic assessment after volume challenge has been proposed as a way to identify heart failure with preserved ejection fraction (HFpEF). However, the normal hemodynamic response to a volume challenge and how age and sex affect this relationship remains unknown.
Methods and Results: Sixty healthy subjects underwent right heart catheterization to measure age- and sex-related normative responses of pulmonary capillary wedge pressure (PCWP) and mean pulmonary arterial pressure (MPAP) to volume loading with rapid saline infusion (100-200 ml/min). Hemodynamic responses to saline infusion in HFpEF (n=11) were then compared to healthy young (<50yrs) and older-aged (≥50yrs) subjects. In healthy subjects, PCWP increased from 10±2 to 16±3 mmHg after ~1L and to 20±3 mmHg after ~2L of saline infusion. Older women displayed a steeper increase in PCWP relative to volume infused (16±4mmHg·L-1·m2) than other 3 groups (p≤0.019). Saline infusion resulted in a greater increase in MPAP relative to cardiac output in women compared to men, irrespective of age. Subjects with HFpEF exhibited a steeper increase in PCWP relative to infused volume (25±12 mmHg·L-1·m2) than healthy young and older subjects (p≤0.005). An increase in PCWP relative to volume infused ≥18 mmHg·L-1·m2 identified HFpEF with 88% sensitivity and 85% specificity.
Conclusion: Filling pressures may rise dramatically with volume loading, even in normal volunteers. Older women and patients with HFpEF exhibit the most dramatic increases in PCWP and MPAP. These findings provide normative data for saline loading in the catheterization lab and may partly explain the greater burden of HFpEF among older-aged women.
- © 2012 by American Heart Association, Inc.