Journal Club 18 July 2012

Paper

Echocardiographic Evaluation of Hemodynamics in Patients With Decompensated Systolic Heart Failure

Presenter:

SP

Summary

Results

Consecutive patients with decompensated heart failure had simultaneous assessment of left ventricular
and right ventricular hemodynamics invasively and by Doppler echocardiography. In 79 patients, the noninvasive
measurements of stroke volume (r
0.83, P0.001), pulmonary artery systolic (r
0.83, P0.001) and diastolic pressure
(r
0.51, P
0.009), and mean right atrial pressure (r
0.85, P0.001) all had significant correlations with invasively acquired measurements. Several Doppler indices had good accuracy in identifying patients with pulmonary capillary wedge pressure 15 mm Hg (area under the curve, 0.86 to 0.92). The recent American Society of Echocardiography/European Association of Echocardiography guidelines were highly accurate (sensitivity, 98%; specificity, 91%) in identifying patients with increased wedge pressure. In 12 repeat studies, Doppler echocardiography readily detected the changes in mean wedge pressure (r
0.75, P
0.005) as well as changes in pulmonary artery systolic pressure and mean right atrial pressure.

Conclusions

Doppler echocardiography provides reliable assessment of right and left ventricular hemodynamics in
patients with decompensated heart failure.

Comments

• A number of participants observed the paucity of evidence supporting routine assessment of hemodynamics in guiding therapy for chronic heart failure (including papers by Lynne Warner Stevenson).
• The consistent relationship of hemodynamics  and prognosis was noted
• The paper choice was motivated by a planned research project
• The chpice of LVEDP pre-a wave for comparison with non-invasive data was noted to be largely based on expert opinion and would also be looked at in proposed study

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