[Therapy of advanced heart failure adapted to hemodynamic objectives acquired by invasive hemodynamic monitoring].
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.
Almeida Júnior
Gustavo Luiz Gouvêa de
GL
Hospital Pró-Cardíaco, Universidade do Estado do Rio de Janeiro, Rua Alfredo Ceschiatti 100, 22775-045 Rio de Janeiro, RJ. gustavogouvea@globo.com
Esporcatte
Roberto
R
Rangel
Fernando Oswaldo Dias
FO
Rocha
Ricardo Mourilhe
RM
Gouvêa e Silva
Gustavo de Miranda
Gde M
Tura
Bernardo Rangel
BR
Jorge
José Kezen Camilo
JK
Drumond
Luiz Eduardo Fonseca
LE
Albanesi Filho
Francisco Manes
FM
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*
D004232:Diuretics; D014665:Vasodilator Agents; D009599:Nitroprusside