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H Y Ruan, Y G Zhang, R Liu
Objective: To compare the acute hemodynamic effects of intravenous fasudil with different dosage on patients with congenital heart defects (CHD) and severe pulmonary arterial hypertension (PAH). Methods: Sixty patients (37±17 years old) with CHD and PAH were consecutively enrolled. All patients underwent heart catheterization. The patients were randomly divided into two groups: the regular dosage group and the large dosage group. At initiation and 30 min after intravenous fasudil(30 mg and 60 mg respectively), the following hemodynamic parameters were measured and calculated: right atrial pressure(RAP), pulmonary arterypressure(PAP) , systemic artery pressure (SAP), pulmonary capillary wedge pressure(PCWP) , pulmonary vascular resistance(PVR) and systemic vascular resistance( SVR), cardiac index (CI) and artery oxygen saturation (SaO(2))...
March 6, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Stephen A McCullough, Michael A Fifer, Pouya Mohajer, Patricia A Lowry, Caitlin O'Callaghan Reen, Aaron L Baggish, Gus J Vlahakes, Yuichi J Shimada
BACKGROUND: The clinical characteristics associated with elevated right atrial pressure (RAP) in hypertrophic cardiomyopathy (HCM) are unknown. Few data exist as to whether elevated RAP has prognostic implications in patients with HCM. This study investigated the clinical correlates and prognostic value of elevated RAP in HCM.Methods and Results:This retrospective cohort study was performed on 180 patients with HCM who underwent right heart catheterization between 1997 and 2014. Elevated RAP was defined as >8 mmHg...
March 9, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
Dirk W Donker, Daniel Brodie, José P S Henriques, Michael Broomé
Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is widely used in cardiogenic shock. It provides systemic perfusion, but left ventricular (LV) unloading is suboptimal. Using a closed-loop, real-time computer model of the human cardiovascular system, cardiogenic shock supported by peripheral VA ECMO was simulated and effects of various adjunct LV unloading interventions were quantified. After VA ECMO initiation (4 L/min) in cardiogenic shock (baseline), hemodynamics improved (mean arterial pressure (MAP) increased to 85 mmHg), while LV overload occurred (10% increase in end-diastolic volume (EDV), and 5 mmHg increase in pulmonary capillary wedge pressure (PCWP))...
March 6, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Yu Horiuchi, Shuzou Tanimoto, Jiro Aoki, Nozomi Fuse, Kazuyuki Yahagi, Keita Koseki, Taishi Okuno, Hiroyoshi Nakajima, Kazuhiro Hara, Kengo Tanabe
BACKGROUND: Mismatch between right- and left-sided filling pressures is poorly understood in heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS: We retrospectively analyzed 170 patients with HFpEF (EF≥40%) who underwent right heart catheterization. Low match (right atrial pressure [RAP]<10mmHg and pulmonary capillary wedge pressure [PCWP]<10mmHg) was 76%, high match (RAP≥10mmHg and PCWP≥22mmHg) was 6.5%, high-R mismatch (RAP≥10mmHg and PCWP<22mmHg) was 12%, and high-L mismatch (RAP<10mmHg and PCWP≥22mmHg) was 5...
April 15, 2018: International Journal of Cardiology
Brian Y Chang, Steven P Keller, Sonya S Bhavsar, Noam Josephy, Elazer R Edelman
The full potential of mechanical circulatory systems in the treatment of cardiogenic shock is impeded by the lack of accurate measures of cardiac function to guide clinicians in determining when to initiate and how to optimally titrate support. The left ventricular end diastolic pressure (LVEDP) is an established metric of cardiac function that refers to the pressure in the left ventricle at the end of ventricular filling and immediately before ventricular contraction. In clinical practice, LVEDP is typically only inferred from, and poorly correlates with, the pulmonary capillary wedge pressure (PCWP)...
February 28, 2018: Science Translational Medicine
Amit Prasad, Ali Ghodsizad, Christoph Brehm, Mark Kozak, Michael Körner, Aly El Banayosy, Kai Singbartl
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides mechanical circulatory support for patients with advanced cardiogenic shock, facilitating myocardial recovery and limiting multi-organ failure. In patients with severely limited left ventricular ejection, peripheral VA-ECMO can further increase left ventricular and left atrial pressures (LAP). Failure to decompress the left heart under these circumstances can result in pulmonary edema and upper body hypoxemia, that is, myocardial and cerebral ischemia...
January 18, 2018: Artificial Organs
Teruhiko Imamura, Colleen Juricek, Ann Nguyen, Ben Chung, Daniel Rodgers, Gabriel Sayer, Nitasha Sarswat, Gene Kim, Jayant Raikhelkar, Takeyoshi Ota, Tae Song, David Onsanger, Daniel Burkhoff, Valluvan Jeevanandam, Nir Uriel
OBJECTIVES: The intraaortic balloon pump (IABP) is currently an essential tool to improve hemodynamics in patients with advanced heart failure (HF). This study investigated predictors for hemodynamic improvement or stabilization with IABP therapy in patients with advanced HF. METHODS: Patients with advanced HF and hemodynamic deterioration treated with IABP were enrolled in this retrospective study. Invasive hemodynamics were measured before IABP implantation and 2 weeks after IABP initiation...
January 15, 2018: Journal of Invasive Cardiology
Michinari Hieda, Joshua Parker, Tanya Rajabi, Naoki Fujimoto, Paul S Bhella, Anand Prasad, Jeffrey L Hastings, Satyam Sarma, Benjamin D Levine
Elevated left ventricular (LV) filling pressures are commonly reported in patients with heart failure with preserved ejection fraction (HFpEF) and are associated with impaired relaxation in diastole. Relaxation has been assessed by Doppler, but the methods for doing so are indirect and heavily influenced by loading conditions. The aim of this study is to assess LV volume-time relation in patients with HFpEF, when correcting for left atrial driving pressure and chamber size, using cardiac magnetic resonance imaging (cMRI)...
December 11, 2017: American Journal of Cardiology
Justin L Grodin, Wilfried Mullens, Matthias Dupont, David O Taylor, Paul M McKie, Randall C Starling, Jeffrey M Testani, W H Wilson Tang
BACKGROUND: Lower serum chloride (Cl) is associated with mortality in heart failure patients and may be more prognostically relevant than sodium. However, the association of hemodynamics and Cl levels is unknown. METHODS: 438 sequential patients with advanced chronic heart failure (ACHF) underwent invasive hemodynamic assessment with measured serum Cl levels during an evaluation for ACHF. Patients were followed for death, heart transplant (HT), or ventricular assist device placement (VAD)...
February 1, 2018: International Journal of Cardiology
Yukari Kobayashi, Naga Lakshmi Sudini, June-Wha Rhee, Marie Aymami, Kegan J Moneghetti, Sara Bouajila, Yuhei Kobayashi, Juyong B Kim, Ingela Schnittger, Jeffery J Teuteberg, Kiran K Khush, William F Fearon, Francois Haddad
OBJECTIVES: This study investigated to define graft dysfunction and to determine its incremental association with long-term outcome after heart transplantation (HT). BACKGROUND: Although graft failure is an established cause of late mortality after HT, few studies have analyzed the prognostic value of graft dysfunction at 1- and 5-year follow-up of HT. METHODS: Patients who underwent HT and completed their first annual evaluation with right heart catheterization and echocardiography at Stanford University between January 1999 and December 2011 were included in the study...
December 2017: JACC. Heart Failure
Ted Feldman, Laura Mauri, Rami Kahwash, Sheldon Litwin, Mark J Ricciardi, Pim van der Harst, Martin Penicka, Peter S Fail, David M Kaye, Mark C Petrie, Anupam Basuray, Scott L Hummel, Rhondalyn Forde-McLean, Christopher D Nielsen, Scott Lilly, Joseph M Massaro, Daniel Burkhoff, Sanjiv J Shah
BACKGROUND: In nonrandomized, open-label studies, a transcatheter interatrial shunt device (IASD, Corvia Medical) was associated with lower pulmonary capillary wedge pressure (PCWP), fewer symptoms, and greater quality of life and exercise capacity in patients with heart failure (HF) and midrange or preserved ejection fraction (EF ≥40%). We conducted the first randomized sham-controlled trial to evaluate the IASD in HF with EF ≥40%. METHODS: REDUCE LAP-HF I (Reduce Elevated Left Atrial Pressure in Patients With Heart Failure) was a phase 2, randomized, parallel-group, blinded multicenter trial in patients with New York Heart Association class III or ambulatory class IV HF, EF ≥40%, exercise PCWP ≥25 mm Hg, and PCWP-right atrial pressure gradient ≥5 mm Hg...
January 23, 2018: Circulation
Anuradha Lala, Yu Guo, Jinfeng Xu, Michele Esposito, Kevin Morine, Richard Karas, Stuart D Katz, Judith S Hochman, Daniel Burkhoff, Navin K Kapur
BACKGROUND: The prevalence and significance of right ventricular dysfunction (RVD) in patients with cardiogenic shock due to acute myocardial infarction (AMI-CS) have not been well characterized. We hypothesized that RVD is common in AMI-CS and associated with worse clinical outcomes. METHODS AND RESULTS: We retrospectively analyzed patients with available hemodynamics enrolled in the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial (n = 139) and registry (n = 258) to identify RVD in AMI-CS...
October 12, 2017: Journal of Cardiac Failure
Masayoshi Oikawa, Atsushi Kobayashi, Kento Wada, Takamasa Sato, Satoshi Suzuki, Akiomi Yoshihisa, Kazuhiko Nakazato, Hitoshi Suzuki, Shu-Ichi Saitoh, Takafumi Ishida, Yasuchika Takeishi
BACKGROUND: Several echocardiographic parameters are currently being employed to evaluate left ventricular (LV) filling pressure. However, these parameters are not always consistent in the clinical setting. We aimed to determine a novel parameter by multiplying log B-type natriuretic peptide (lnBNP) and mitral inflow early and late diastolic filling velocity ratio (E/A) for the prediction of pulmonary capillary wedge pressure (PCWP). METHODS AND RESULTS: One hundred and ninety-eight patients suspected of chronic heart failure were analyzed...
October 12, 2017: Journal of Cardiac Failure
Holger Thiele, Alexander Jobs, Dagmar M Ouweneel, Jose P S Henriques, Melchior Seyfarth, Steffen Desch, Ingo Eitel, Janine Pöss, Georg Fuernau, Suzanne de Waha
Aims: Evidence on the impact on clinical outcome of active mechanical circulatory support (MCS) devices in cardiogenic shock (CS) is scarce. This collaborative meta-analysis of randomized trials thus aims to investigate the efficacy and safety of percutanzeous active MCS vs. control in CS. Methods and results: Randomized trials comparing percutaneous active MCS to control in patients with CS were identified through searches of medical literature databases. Risk ratios (RR) and 95% confidence intervals (95% CI) were calculated to analyse the primary endpoint of 30-day mortality and device-related complications including bleeding and leg ischaemia...
December 14, 2017: European Heart Journal
Sharon Chen, John C Dykes, Doff B McElhinney, Robert J Gajarski, Andrew Y Shin, Seth A Hollander, Melanie E Everitt, Jack F Price, Ravi R Thiagarajan, Steven J Kindel, Joseph W Rossano, Beth D Kaufman, Lindsay J May, Elizabeth Pruitt, David N Rosenthal, Christopher S Almond
Aims: To evaluate associations between haemodynamic profiles and symptoms, end-organ function and outcome in children listed for heart transplantation. Methods and results: Children <18 years listed for heart transplant between 1993 and 2013 with cardiac catheterization data [pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), and cardiac index (CI)] in the Pediatric Heart Transplant Study database were included. Outcomes were New York Heart Association (NYHA)/Ross classification, renal and hepatic dysfunction, and death or clinical deterioration while on waitlist...
October 7, 2017: European Heart Journal
H R Omar, M Guglin
INTRODUCTION: We aimed to identify the best tools from history and physical examination that predict severity of heart failure (HF) exacerbation among patients with an ejection fraction (EF) ≤ 30%. METHODS: Patients enrolled in the ESCAPE trial were divided into tertiles according to the combined value of pulmonary capillary wedge pressure (PCWP) and right atrial pressure (RAP) which we used as a marker of volume loading of both pulmonary and systemic compartments...
October 9, 2017: Herz
Emil Wolsk, David Kaye, Barry A Borlaug, Daniel Burkhoff, Dalane W Kitzman, Jan Komtebedde, Carolyn S P Lam, Piotr Ponikowski, Sanjiv J Shah, Finn Gustafsson
AIMS: Patients with heart failure and preserved ejection fraction (HFpEF) are characterized by functional impairment and an abnormal haemodynamic response to exercise. The six-minute walk test (6MWT) serves as a standardized test for functional capacity quantification in heart failure patients, and is associated with cardiovascular outcomes. However, as the association between 6MWT and haemodynamic parameters during rest and exercise in HFpEF patients is unknown, we sought to elucidate this relationship...
September 26, 2017: European Journal of Heart Failure
Wojciech Gilewski, Jarosław Pietrzak, Joanna Banach, Robert Bujak, Jan Błażejewski, Danuta Karasek, Łukasz Wołowiec, Władysław Sinkiewicz
The aim of the study was to verify prognostic value of selected echocardiographic (UKG), impedance cardiography (ICG), and right heart catheterization (RHC) parameters in systolic heart failure (HF). UKG, ICG, and RHC were performed in 46 patients with chronic HF with ejection fraction <35%. During a 1-year follow-up, composite endpoint (death or hospitalization due to HF exacerbation) was achieved by 23 (50.0%) patients. Analysis of receiver operating characteristic (ROC) curves identified UKG parameters: inferior vena cava diameter on inspiration (IVCinsp) >13 mm [area under curve (AUC), 0...
September 22, 2017: Heart and Vessels
Anna Koulova, Alan L Gass, Saikrishna Patibandla, Chhaya Aggarwal Gupta, Wilbert S Aronow, Gregg M Lanier
Pulmonary hypertension in left heart disease (PH-LHD) commonly complicates prolonged heart failure (HF). When advanced, the PH becomes fixed or out of proportion and is associated with increased morbidity and mortality in patients undergoing orthotopic heart transplant (OHT). To date, the only recommended treatment of out of proportion PH is the treatment of the underlying HF by reducing the pulmonary capillary wedge pressure (PCWP) with medications and often along with use of mechanical circulatory support...
August 2017: Journal of Thoracic Disease
Magdy F Iskander, Todd B Seto, Ruthsenne Rg Perron, Eunjung Lim, Farhan Qazi
OBJECTIVE: The purpose of this study is to evaluate the accuracy of a noninvasive radiofrequency-based device, the Cardio-Pulmonary Stethoscope (CPS), to monitor heart and respiration rates and detect changes in lung water content in human experiments and clinical trials. METHODS: Three human populations (healthy subjects (n=4), heart failure (n=12) and hemodialysis (n=13) patients) were enrolled in this study. The study was conducted at the University of Hawaii and The Queen's Medical Center in Honolulu, HI...
August 14, 2017: IEEE Transactions on Bio-medical Engineering
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