[Therapy of advanced heart failure adapted to hemodynamic objectives acquired by invasive hemodynamic monitoring].

Abstract:

OBJECTIVE:To assess advanced heart failure (HF) treatment in relation to reduction of ventricular filling pressures, with the use of greater doses of vasodilators, through invasive hemodynamic monitoring. METHODS:Nineteen advanced HF patients were studied, in whom Swan-Ganz catheter was inserted to direct administration of diuretic intravenously (IV) and sodium nitroprusside, with the aim of significantly reduce ventricular filling pressures. After achieving such objective or 48 hours, oral drugs were introduced until venous medicines were removed, keeping hemodynamic benefit. RESULTS:From 19 patients studied, 16 (84%) were of male sex. The average age was 66 +/- 11.4 years old; average ejection fraction was 26 +/- 6.3%; 2 patients (10.5%) showed functional class (FC) III and 17 (89.5%), FC IV. There was a decrease of pulmonary artery occlusion pressure from 23 +/- 11.50 mmHg to 16 +/- 4.05 mmHg (p = 0.008), of systemic vascular resistance index from 3,023 +/- 1,153.71 dynes/s/cm-5/m(2) to 1,834 +/- 719.34 dynes/s/cm-5/m(2) (p = 0.0001) and an increase of cardiac index from 2.1 +/- 0.56 l/min/m(2) to 2.8 +/- 0.73 l/min/m(2) (p = 0.0003). A subgroup with hypovolemia was identified. CONCLUSION:It was possible to reduce ventricular filling pressures to significantly lower values, obtaining a significant improvement of cardiac index, systemic vascular resistance index and pulmonary artery mean pressure, by using significantly higher doses of vasodilators.

journal_name

Arq Bras Cardiol

authors

Almeida Júnior GL,Esporcatte R,Rangel FO,Rocha RM,Gouvêa e Silva Gde M,Tura BR,Jorge JK,Drumond LE,Albanesi Filho FM

doi

10.1590/s0066-782x2005001700004

subject

Has Abstract

pub_date

2005-10-01 00:00:00

pages

247-53

issue

4

eissn

0066-782X

issn

1678-4170

pii

S0066-782X2005001700004

journal_volume

85

pub_type

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