Response of the right ventricle to acute pulmonary vasodilation predicts the outcome in patients with advanced heart failure and pulmonary hypertension

• Published in: The American heart journal 2003-02, Vol.145 (2), p.310-316
• Main Authors: Gavazzi, Antonello, Ghio, Stefano, Scelsi, Laura, Campana, Carlo, Klersy, Catherine, Serio, Alessandra, Raineri, Claudia, Tavazzi, Luigi
• Format: Article
• Language: English
• Subjects: Aged; Analysis of Variance; Biological and medical sciences; Blood pressure; Cardiac Catheterization - methods; Cardiology; Cardiology. Vascular system; Cardiotonic Agents; Female; Heart; Heart attacks; Heart Failure - drug therapy; Heart Failure - mortality; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart Transplantation; Hemodynamics - drug effects; Hemodynamics - physiology; Humans; Hypertension, Pulmonary - drug therapy; Hypertension, Pulmonary - mortality; Hypertension, Pulmonary - physiopathology; Male; Medical sciences; Middle Aged; Mortality; Nitroglycerin - therapeutic use; Prognosis; Proportional Hazards Models; Stroke Volume - drug effects; Survival Analysis; Vascular Resistance - drug effects; Vascular Resistance - physiology; Vasodilator Agents - therapeutic use; Ventricular Dysfunction, Left - complications; Ventricular Function, Right - drug effects; Ventricular Function, Right - physiology
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1067/mhj.2003.146

Objectives This study was designed to assess whether testing of potential reversibility of pulmonary hypertension (PHT) may be a useful means of defining the short-term prognosis of patients with advanced heart failure and elevated pulmonary artery pressure. In such patients, the reversibility of PHT after acute vasodilator administration is associated with a low early mortality rate after heart transplantation. However, its short-term prognostic value has not yet been determined. Methods and Results Between 1994 and 1998, 76 patients with advanced heart failure and PHT underwent right heart cathetherization. The hemodynamic measurements, including thermodilution-derived right ventricular ejection fraction, were repeated after an intravenous bolus of nitroglycerin (NTG). During a median follow-up period of 8.2 months (25% and 75% centiles, 3.3 and 18.9 months), 47 patients had a cardiac event (death or urgent heart transplantation). With Cox survival analysis, a multivariate model that included the New York Heart Association class and the hemodynamic variables obtained after NTG administration allowed a better assessement of the short-term prognosis of the patients than a model including the baseline variables. The evaluation of right ventricular function during the acute NTG-induced pulmonary vasodilation was of critical importance in obtaining such a refinement in the prognostic stratification. Conclusions The prognostic evaluation of patients with advanced heart failure and PHT should include the assessment of the changes of right ventricular ejection fraction after acute afterload reduction. (Am Heart J 2003;145:310-6.)