title: [Therapy of advanced heart failure adapted to hemodynamic objectives acquired by invasive hemodynamic monitoring].
abstract: OBJECTIVE
  To assess advanced heart failure (HF) treatment in relation to reduction of ventricular filling pressures, with the use of greater doses of vasodilators, through invasive hemodynamic monitoring.
  
  
  METHODS
  Nineteen advanced HF patients were studied, in whom Swan-Ganz catheter was inserted to direct administration of diuretic intravenously (IV) and sodium nitroprusside, with the aim of significantly reduce ventricular filling pressures. After achieving such objective or 48 hours, oral drugs were introduced until venous medicines were removed, keeping hemodynamic benefit.
  
  
  RESULTS
  From 19 patients studied, 16 (84%) were of male sex. The average age was 66 +/- 11.4 years old; average ejection fraction was 26 +/- 6.3%; 2 patients (10.5%) showed functional class (FC) III and 17 (89.5%), FC IV. There was a decrease of pulmonary artery occlusion pressure from 23 +/- 11.50 mmHg to 16 +/- 4.05 mmHg (p = 0.008), of systemic vascular resistance index from 3,023 +/- 1,153.71 dynes/s/cm-5/m(2) to 1,834 +/- 719.34 dynes/s/cm-5/m(2) (p = 0.0001) and an increase of cardiac index from 2.1 +/- 0.56 l/min/m(2) to 2.8 +/- 0.73 l/min/m(2) (p = 0.0003). A subgroup with hypovolemia was identified.
  
  
  CONCLUSIONS
  It was possible to reduce ventricular filling pressures to significantly lower values, obtaining a significant improvement of cardiac index, systemic vascular resistance index and pulmonary artery mean pressure, by using significantly higher doses of vasodilators.
authors.affiliation: Hospital Pró-Cardíaco, Universidade do Estado do Rio de Janeiro, Rua Alfredo Ceschiatti 100, 22775-045 Rio de Janeiro, RJ. gustavogouvea@globo.com
authors.forename: Gustavo Luiz Gouvêa de
authors.initials: GL
authors.lastname: Almeida Júnior
authors.forename: Roberto
authors.initials: R
authors.lastname: Esporcatte
authors.forename: Fernando Oswaldo Dias
authors.initials: FO
authors.lastname: Rangel
authors.forename: Ricardo Mourilhe
authors.initials: RM
authors.lastname: Rocha
authors.forename: Gustavo de Miranda
authors.initials: Gde M
authors.lastname: Gouvêa e Silva
authors.forename: Bernardo Rangel
authors.initials: BR
authors.lastname: Tura
authors.forename: José Kezen Camilo
authors.initials: JK
authors.lastname: Jorge
authors.forename: Luiz Eduardo Fonseca
authors.initials: LE
authors.lastname: Drumond
authors.forename: Francisco Manes
authors.initials: FM
authors.lastname: Albanesi Filho
mesh_terms: D001794:Blood Pressure / Q000528:radiation effects; D004231:Diuresis / Q000502:physiology; D004232:Diuretics / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D020896:Hypovolemia / Q000503:physiopathology; D007668:Kidney / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009599:Nitroprusside / Q000008:administration & dosage*; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000503:physiopathology; D014665:Vasodilator Agents / Q000008:administration & dosage*; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D017725:Ventricular Pressure / Q000187:drug effects*
chemical_list: D004232:Diuretics; D014665:Vasodilator Agents; D009599:Nitroprusside