title: Implications of the hemodynamic optimization approach guided by right heart catheterization in patients with severe heart failure.
abstract: OBJECTIVE
  To report the hemodynamic and functional responses obtained with clinical optimization guided by hemodynamic parameters in patients with severe and refractory heart failure.
  
  
  METHODS
  Invasive hemodynamic monitoring using right heart catheterization aimed to reach low filling pressures and peripheral resistance. Frequent adjustments of intravenous diuretics and vasodilators were performed according to the hemodynamic measurements.
  
  
  RESULTS
  We assessed 19 patients (age = 48+/-12 years and ejection fraction = 21+/-5%) with severe heart failure. The intravenous use of diuretics and vasodilators reduced by 12 mm Hg (relative reduction of 43%) pulmonary artery occlusion pressure (P<0.001), with a concomitant increment of 6 mL per beat in stroke volume (relative increment of 24%, P<0.001). We observed significant associations between pulmonary artery occlusion pressure and mean pulmonary artery pressure (r=0.76; P<0.001) and central venous pressure (r=0.63; P<0.001). After clinical optimization, improvement in functional class occurred (P< 0.001), with a tendency towards improvement in ejection fraction and no impairment to renal function.
  
  
  CONCLUSIONS
  Optimization guided by hemodynamic parameters in patients with refractory heart failure provides a significant improvement in the hemodynamic profile with concomitant improvement in functional class. This study emphasizes that adjustments in blood volume result in immediate benefits for patients with severe heart failure.
authors.affiliation: Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brasil.
authors.forename: Luís E
authors.initials: LE
authors.lastname: Rohde
authors.forename: Thiago
authors.initials: T
authors.lastname: Furian
authors.forename: Candice
authors.initials: C
authors.lastname: Campos
authors.forename: Andreia
authors.initials: A
authors.lastname: Biolo
authors.forename: Eneida
authors.initials: E
authors.lastname: Rabelo
authors.forename: Murilo
authors.initials: M
authors.lastname: Foppa
authors.forename: Nadine
authors.initials: N
authors.lastname: Clausell
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D006328:Cardiac Catheterization / Q000379:methods*; D002303:Cardiac Output, Low / Q000188:drug therapy / Q000503:physiopathology; D004232:Diuretics / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D005665:Furosemide / Q000494:pharmacology / Q000627:therapeutic use; D006333:Heart Failure / Q000503:physiopathology* / Q000628:therapy; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009599:Nitroprusside / Q000494:pharmacology / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D004232:Diuretics; D014665:Vasodilator Agents; D009599:Nitroprusside; D005665:Furosemide