Journal of Cardiac Failure
Volume 17, Issue 4 , Pages 282-291, April 2011

Hemodynamic Factors Associated With Acute Decompensated Heart Failure: Part 1—Insights into Pathophysiology

  • Michael R. Zile, MD

      Affiliations

    • Medical University of South Carolina and RHJ Department of Veterans Affairs Medical Center, Charleston, South Carolina
    • Corresponding Author InformationReprint requests: Michael R. Zile, MD, Division of Cardiology, Medical University of South Carolina, Ashley River Towers, Room 7042, 25 Courtenay Drive, Charleston, SC 29425. Tel: 843-792-6866; Fax: 843-792-7771.
    • ,
  • Philip B. Adamson, MD

      Affiliations

    • Oklahoma Foundation for Cardiovascular Research, Oklahoma Heart Hospital, Oklahoma City, Oklahoma
    • ,
  • Yong K. Cho, PhD

      Affiliations

    • Medtronic, Minneapolis, Minnesota
    • ,
  • Tom D. Bennett, PhD

      Affiliations

    • Medtronic, Minneapolis, Minnesota
    • ,
  • Robert C. Bourge, MD

      Affiliations

    • University of Alabama, Birmingham, Alabama
    • ,
  • Mark F. Aaron, MD

      Affiliations

    • St Thomas Hospital, Nashville, Tennessee
    • ,
  • Juan M. Aranda Jr., MD

      Affiliations

    • University of Florida, Gainesville, Florida
    • ,
  • William T. Abraham, MD

      Affiliations

    • Ohio State University, Columbus, Ohio
    • ,
  • Lynne Warner Stevenson, MD

      Affiliations

    • Brigham and Women’s Hospital, Boston, Massachusetts
    • ,
  • Fred J. Kueffer, MS

      Affiliations

    • Medtronic, Minneapolis, Minnesota

Received 28 July 2010; received in revised form 24 January 2011; accepted 28 January 2011. published online 28 February 2011.

Abstract 

Background

The purpose of this study was to determine which pressure-based hemodynamic factor was most closely associated with the transition from chronic compensated to acute decompensated heart failure.

Methods and Results

Intracardiac pressures were retrospectively examined in 274 heart failure patients using an implantable hemodynamic monitor. The relationship between the development of a heart failure–related event (HFRE) and 3 pressure variables were analyzed: peak estimated pulmonary artery diastolic pressure (ePAD) at the time of an HFRE, change in ePAD from baseline to peak pressure, and the product of ePAD pressure and time (P×T) calculated as the area under the pressure-versus-time curve from baseline to peak pressure. Patients without an HFRE served as control subjects. Peak ePAD and change in ePAD were not closely associated with the development of an HFRE. In patients with an HFRE, P×T was 221 ± 130 mm Hg·days with only 4% of the P×T values <60 mm Hg·days. In contrast, in patients without an HFRE, the P×T was 5 ± 23 with only 4% of the P×T values >60 mm Hg·days.

Conclusions

The product of small increases in pressure that occur over an extended period of time (P×T) is the pressure-based hemodynamic factor most closely associated with the transition to acute decompensated heart failure.

Key Words: Heart failure, hemodynamics, acute decompensation

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 Funding: Supported by Medtronic, Minneapolis, Minnesota.

 Study registration: ClinicalTrials.gov identifier NCT00643279.

 See page 290 for disclosure information.

PII: S1071-9164(11)00025-X

doi:10.1016/j.cardfail.2011.01.010

Journal of Cardiac Failure
Volume 17, Issue 4 , Pages 282-291, April 2011

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