TY - JOUR
T1 - Importance of Venous Congestion for Worsening of Renal Function in Advanced Decompensated Heart Failure
AU - Mullens, Wilfried
AU - Abrahams, Zuheir
AU - Francis, Gary S.
AU - Sokos, George
AU - Taylor, David O.
AU - Starling, Randall C.
AU - Young, James B.
AU - Tang, W. H Wilson
PY - 2009/2/17
Y1 - 2009/2/17
N2 - Objectives: To determine whether venous congestion, rather than impairment of cardiac output, is primarily associated with the development of worsening renal function (WRF) in patients with advanced decompensated heart failure (ADHF). Background: Reduced cardiac output is traditionally believed to be the main determinant of WRF in patients with ADHF. Methods: A total of 145 consecutive patients admitted with ADHF treated with intensive medical therapy guided by pulmonary artery catheter were studied. We defined WRF as an increase of serum creatinine ≥0.3 mg/dl during hospitalization. Results: In the study cohort (age 57 ± 14 years, cardiac index 1.9 ± 0.6 l/min/m2, left ventricular ejection fraction 20 ± 8%, serum creatinine 1.7 ± 0.9 mg/dl), 58 patients (40%) developed WRF. Patients who developed WRF had a greater central venous pressure (CVP) on admission (18 ± 7 mm Hg vs. 12 ± 6 mm Hg, p < 0.001) and after intensive medical therapy (11 ± 8 mm Hg vs. 8 ± 5 mm Hg, p = 0.04). The development of WRF occurred less frequently in patients who achieved a CVP <8 mm Hg (p = 0.01). Furthermore, the ability of CVP to stratify risk for development of WRF was apparent across the spectrum of systemic blood pressure, pulmonary capillary wedge pressure, cardiac index, and estimated glomerular filtration rates. Conclusions: Venous congestion is the most important hemodynamic factor driving WRF in decompensated patients with advanced heart failure.
AB - Objectives: To determine whether venous congestion, rather than impairment of cardiac output, is primarily associated with the development of worsening renal function (WRF) in patients with advanced decompensated heart failure (ADHF). Background: Reduced cardiac output is traditionally believed to be the main determinant of WRF in patients with ADHF. Methods: A total of 145 consecutive patients admitted with ADHF treated with intensive medical therapy guided by pulmonary artery catheter were studied. We defined WRF as an increase of serum creatinine ≥0.3 mg/dl during hospitalization. Results: In the study cohort (age 57 ± 14 years, cardiac index 1.9 ± 0.6 l/min/m2, left ventricular ejection fraction 20 ± 8%, serum creatinine 1.7 ± 0.9 mg/dl), 58 patients (40%) developed WRF. Patients who developed WRF had a greater central venous pressure (CVP) on admission (18 ± 7 mm Hg vs. 12 ± 6 mm Hg, p < 0.001) and after intensive medical therapy (11 ± 8 mm Hg vs. 8 ± 5 mm Hg, p = 0.04). The development of WRF occurred less frequently in patients who achieved a CVP <8 mm Hg (p = 0.01). Furthermore, the ability of CVP to stratify risk for development of WRF was apparent across the spectrum of systemic blood pressure, pulmonary capillary wedge pressure, cardiac index, and estimated glomerular filtration rates. Conclusions: Venous congestion is the most important hemodynamic factor driving WRF in decompensated patients with advanced heart failure.
KW - cardiac index
KW - decompensated heart failure
KW - venous congestion
KW - worsening renal function
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U2 - 10.1016/j.jacc.2008.05.068
DO - 10.1016/j.jacc.2008.05.068
M3 - Article
C2 - 19215833
AN - SCOPUS:59649118099
SN - 0735-1097
VL - 53
SP - 589
EP - 596
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 7
ER -
