The role of cardiac power and systemic vascular resistance in the pathophysiology and diagnosis of patients with acute congestive heart failure.
OBJECTIVE
Conventional hemodynamic indexes (cardiac index (CI), and pulmonary capillary wedge pressure) are of limited value in the diagnosis and treatment of patients with acute congestive heart failure (CHF).


METHODS
We measured CI, wedge pressure, right atrial pressure (RAP) and mean arterial blood pressure (MAP) in 89 consecutive patients admitted due to acute CHF (exacerbated systolic CHF, n=56; hypertensive crisis, n=5; pulmonary edema, n=11; and cardiogenic shock, n=17) and in two control groups. The two control groups were 11 patients with septic shock and 20 healthy volunteers. Systemic vascular resistance index (SVRi) was calculated as SVRi=(MAP-RAP)/CI. Cardiac contractility was estimated by the cardiac power index (Cpi), calculated as CIxMAP.


CONCLUSIONS
We found that CI<2.7 l/min/m(2) and wedge pressure >12 mmHg are found consistently in patients with acute CHF. However, these measures often overlapped in patients with different acute CHF syndromes, while Cpi and SVRi permitted more accurate differentiation. Cpi was low in patients with exacerbated systolic CHF and extremely low in patients with cardiogenic shock, while SVRi was increased in patients with exacerbated systolic CHF and extremely high in patients with pulmonary edema. By using a two-dimensional presentation of Cpi vs. SVRi we found that these clinical syndromes can be accurately characterized hemodynamically. The paired measurements of each clinical group segregated into a specific region on the Cpi/SVRi diagnostic graph, that could be mathematically defined by a statistically significant line (Lambda=0.95). Therefore, measurement of SVRi and Cpi and their two-dimensional graphic representation enables accurate hemodynamic diagnosis and follow-up of individual patients with acute CHF.
Cotter
Gad
G
Cardiology Department, Assaf-Harofeh Medical Center, 70300, Zerifin, Israel. cotterg@hotmail.com
Moshkovitz
Yaron
Y
Kaluski
Edo
E
Milo
Olga
O
Nobikov
Ylia
Y
Schneeweiss
Adam
A
Krakover
Ricardo
R
Vered
Zvi
Z
D000368:Aged; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure; D012770:Shock, Cardiogenic / Q000503:physiopathology; D013815:Thermodilution; D014655:Vascular Resistance / Q000502:physiology*; D016276:Ventricular Function / Q000502:physiology*