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Echo‐Doppler and clinical evaluations to define hemodynamic profile in patients with chronic heart failure: accuracy and influence on therapeutic management
Author(s) -
Capomolla Soccorso,
Ceresa Monica,
Pinna GianDomenico,
Maestri Roberto,
La Rovere Maria Teresa,
Febo Oreste,
Rossi Angelo,
Paganini Vincenzo,
Caporotondi Angelo,
Guazzotti Giampaolo,
Gnemmi Marco,
Mortara Andrea,
Cobelli Franco
Publication year - 2005
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2004.07.013
Subject(s) - medicine , hemodynamics , heart failure , cardiology , doppler echocardiography , ejection fraction , doppler effect , cardiac index , cardiac output , blood pressure , diastole , physics , astronomy
Background Correct classification of chronic heart failure (CHF) patients by dual evidence of congestion and adequate perfusion is the primary clinical focus for management. Objectives To evaluate the accuracy of echo‐Doppler compared with clinical evaluation in determining the hemodynamic profile of patients with CHF; and to compare therapeutic changes based on hemodynamic or echo‐Doppler findings. Methods Three hundred and sixty‐six consecutive CHF patients (ejection fraction 25±7%) in sinus rhythm, undergoing evaluation for cardiac transplantation, underwent physical examination prior to right heart catheterization and echo‐Doppler studies. Subsequently, patients were randomized to therapeutic optimization using either right heart catheterization or echo‐Doppler data. The end‐points were: identification of low cardiac output (cardiac index <2.2 l/min/m 2 ); high pulmonary wedge pressure (PWP >18 mm Hg); high right atrial pressure (RAP >5 mm Hg) and analysis of therapeutic changes made in response to the right heart catheterization and echo‐Doppler studies. Results Echo‐Doppler showed better accuracy in estimating abnormal hemodynamic indices than clinical variables (cardiac index <2.2 l/min/m 2 : echo positive predictive accuracy (PPA) 98% vs. clinical PPA 52% p <0.00001; PWP >18 mm Hg: echo PPA 85% vs. clinical PPA 76% p =0.0011; RAP >5 mm Hg: echo PPA 82% vs. clinical PPA 57% p <0.00001). When applied to individual patients, the echo‐Doppler assessment was more accurate than clinical evaluation in defining the different hemodynamic profiles: wet/cold (89% vs. 13%, p <0.0001); wet/warm (73% vs. 30%, p <0.0001); dry/cold (68% vs. 12%, p <0.0001); dry/warm (88% vs. 51%, p <0.0001). Therapeutic decision‐making based on echo‐Doppler findings was similar to that based on hemodynamics. Conclusion Echo‐Doppler hemodynamic monitoring proved accurate in estimating hemodynamic profiles and influenced therapeutic management.