Echo-Doppler and clinical evaluations to define hemodynamic profile in patients with chronic heart failure: Accuracy and influence on therapeutic management

Soccorso Capomolla, Monica Ceresa, GianDomenico Pinna, Roberto Maestri, Maria Teresa La Rovere, Oreste Febo, Angelo Rossi, Vincenzo Paganini, Angelo Caporotondi, Giampaolo Guazzotti, Marco Gnemmi, Andrea Mortara, Franco Cobelli

Research output: Contribution to journalArticlepeer-review

Abstract

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); 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: echo positive predictive accuracy (PPA) 98% vs. clinical PPA 52% p18 mm Hg: echo PPA 85% vs. clinical PPA 76% p=0.0011; RAP >5 mm Hg: echo PPA 82% vs. clinical PPA 57% p

Original languageEnglish
Pages (from-to)624-630
Number of pages7
JournalEuropean Journal of Heart Failure
Volume7
Issue number4
DOIs
Publication statusPublished - Jun 2005

Keywords

  • Chronic heart failure
  • Clinical signs
  • Echo-Doppler

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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