LaVone Smith

Plasma Volume and Renal Function Predict Six-Month Survival after Hospitalization for Acute Decompensated Heart Failure

Background: Plasma volume (PV) is contracted in stable patients with heart failure (HF) due to decongestion strategies. On the other hand, increased PV can adversely affect the trajectory of HF. We therefore examined the effects of increased percentage change in PV (%ΔPV), blood urea nitrogen (BUN), and %ΔPV stratified by BUN and glomerular filtration rate (GFR) on survival after discharge in patients hospitalized for acute decompensated HF (ADHF). Methods: We used the Strauss-Davis-Rosenbaum formula to calculate the %ΔPV between baseline and hospital discharge in a cohort from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial (ESCAPE). Kaplan-Meier curves were constructed for survival over 6 months. Cox proportional hazards regression was used to obtain adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for the associations between survival after discharge and %ΔPV, BUN, and %ΔPV stratified by BUN and GFR. Results: Of the 324 patients included in our study (age 56.1 ± 13.6 years, 26.5% female), those with increased or no %ΔPV at discharge were less likely to survive at 6 months compared with those having reduced %ΔPV (log rank, p = 0.0093). Increased %ΔPV (HR 1.08 per 10% increase; 95% CI: 1.02-1.14) and increased BUN at discharge (HR 1.02 per mg/dL; 95% CI: 1.01-1.03) were independently associated with worse survival. Decreasing %ΔPV had a greater association with improved survival in patients with discharge BUN <31 mg/dL (p = 0.02) and discharge GFR >40 mL/min/1.73 m2 (p = 0.047). Conclusions: Increased %ΔPV and BUN at discharge predicted worse 6-month survival in patients with ADHF. Decreased %ΔPV with low BUN or high GFR at discharge was associated with improved survival.

Pulmonary Hypertension and Related Disorders

Pulmonary Hypertension (PH) is an elevation in pulmonary artery pressure to 25 mmHg or more. It most commonly results from left heart disease, but can also be the result of lung disease, pulmonary embolism, and autoimmune diseases among others. Pulmonary arterial hypertension (PAH) is a subset of PH characterized by normal left heart pressure and elevated pulmonary vascular resistance. Diagnosis of PH is made by right heart catheterization. Catheterization provides useful information in characterizing the etiology of PH and risk stratification. Additional procedures during catheterization, including exercise and volume challenge, can be useful in unmasking diastolic heart failure or exercise induced PH. Establishing the correct diagnosis and determining the etiology is critical when deciding on a treatment strategy, as pulmonary vasodilators can worsen rather than improve symptoms in certain patient populations. This chapter will review the classification of PH and characteristic hemodynamic findings on right heart catheterization and will provide a standardized approach to diagnosis and treatment.

Outcomes of patients with cardiogenic shock treated with TandemHeart® percutaneous ventricular assist device: Importance of support indication and definitive therapies as determinants of prognosis

The objective of this study was to review the characteristics of patients in cardiogenic shock treated with TandemHeart® percutaneous ventricular assist device (pVAD) to determine influential predictors of survival.