Abstract 15324: Intracardiac Pressure Mismatch is Associated With Renal Recovery Following Medical Therapy in Acute Decompensated Heart Failure
Background: Venous congestion is a crucial factor for worsening renal function (WRF) in the setting of acute decompensated heart failure (ADHF). However, the relationship between elevated left- and right-sided intracardiac pressures and WRF has not been elucidated.
Hypothesis: Increased venous congestion in the setting of relatively lower pulmonary capillary wedge pressure (PCWP) is associated with WRF in ADHF.
Methods: A total of 330 consecutive patients admitted with acute decompensated heart failure were treated with intensive medical therapy and had invasive hemodynamic monitoring. High right atrial pressure (RAP) mismatch is defined as above-median RAP (≥10 mmHg) and below-median PCWP (< 22 mm Hg).
Results: In the study cohort (age 57±13 years, cardiac index 1.7 (IQR 1.4, 2.0) L/min/m2, LVEF 15% (IQR 10, 21), serum creatinine 1.4 mg/dl (IQR 1.1, 2.0)), 66 (20%) had high RAP mismatch. High RAP mismatch had lower mean arterial pressure (p=0.0003), lower pulmonary arterial systolic and diastolic pressures (both p<0.0001), higher pulmonary vascular resistance (p=0.0001), higher baseline creatinine (p=0.0095), and a non-significant trend towards higher peak creatinine (p=0.06) when compared to those with high RAP but no mismatch. Following protocol-driven, hemodynamically-guided medical therapy (including diuretics and vasoactive drugs), patients with high RAP mismatch were more likely to have greater improvement in renal function (IRF) and less likely to have WRF when compared to those with high RAP but no mismatch (Figure).
Conclusion: In ADHF with predominantly venous congestion, the presence of intracardiac pressure mismatch is associated with a greater likelihood of reversible renal dysfunction following hemodynamically-guided medical therapy. These findings support the hypothesis that relieving systemic venous congestion may be helpful to restore renal function particularly in the subset of patients with less prominent backward failure.
- © 2013 by American Heart Association, Inc.