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

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