Abstract 19547: Novel Hemodynamic Subsets in Predicting the Need for Inotropic Support in Heart Failure
Introduction: Forrester hemodynamic subsets, originally applied to acute myocardial infarction, were widely used for clinical assessment and treatment of any types of heart failure (HF). We aimed to elucidate the best hemodynamic parameter to propose novel hemodynamic subsets in predicting the need for inotropic support in patients with chronic HF.
Methods: Consecutive 202 patients with HF (66 ± 16 years old, 138 males) underwent right heart catheterization (RHC) before initiation of in-hospital pharmacological therapies for HF within 72 hours after hospital admission between January 2011 and March 2014. Patients who required urgent treatment before RHC were excluded. Left ventricular stroke work index (LVSWI) was estimated by the formula: (mean blood pressure - mean pulmonary capillary wedge pressure (mPCWP)) * stroke volume index * 0.0136 (g/m2/beat).
Results: Although 186 patients were successfully treated with diuretics and/or vasodilators, 16 (7.9 %) patients required inotropic support during hospitalization for symptom relief and hemodynamic improvement. LVSWI and mean right atrial pressure (mRAP) were identified as the independent predictor of inotropic need in logistic regression analysis (95% Cl, 0.80 to 0.97, p<0.01, and 95% CI, 1.13 to 1.54, p<0.01, respectively) among hemodynamic variables including cardiac index, mPCWP, mean pulmonary artery pressure, mRAP, pulmonary and systemic vascular resistance index, left and right ventricular stroke work index, and systolic blood pressure and pulse pressure. The combination of LVSWI and mRAP had greater ability for predicting the need for inotropic support compared with the use of the Forrester hemodynamic subsets (Figure).
Conclusions: The novel hemodynamic subsets based on combined RHC-derived LVSWI and mRAP has the great utility in predicting the need for inotropic support and can guide an individualized therapeutic strategy in HF.
Author Disclosures: M. Tanimura: None. K. Dohi: None. T. Takeuchi: None. Y. Sato: None. E. Sugiura: None. N. Kumagai: None. S. Nakamori: None. N. Fujimoto: None. N. Yamada: None. M. Nakamura: None. M. Ito: None.
This research has received full or partial funding support from the American Heart Association.
- © 2014 by American Heart Association, Inc.