Prognostic factors of acute heart failure in patients with pulmonary arterial hypertension.
Acute right ventricular failure in the setting of pulmonary arterial hypertension (PAH) often requires hospitalisation in intensive care units (ICU) to manage the subsequent low cardiac output and its consequences. There are very few data on these acute events. We recorded demographic, clinical and biological data and therapy in consecutive patients suffering from acute right heart failure requiring catecholamine treatment in the ICU of the French referral centre for pulmonary hypertension. These variables were analysed according to the survival status in ICU. 46 patients were included, the mean age was 50.3 yrs. ICU mortality was 41%. We found no difference in terms of demographics, clinical data, last haemodynamic measurements at admission. Systemic arterial pressure was significantly lower in the subgroup of patients whose clinical course was fatal. Plasma brain natriuretic peptide (BNP), C-reactive protein (CRP), serum sodium and creatinine at admission correlated with survival. Demonstration of an infection during the ICU stay was associated with a worse prognosis. These preliminary results underline the importance of some simple clinical and biological parameters in the prognostic evaluation of acute heart failure in the setting of PAH. Whether these parameters can guide therapy needs to be further investigated.
Sztrymf
B
B
Service de Pneumologie et Réanimation Respiratoire, Centre des Maladies Vasculaires Pulmonaires, Hôpital Antoine Béclère, Assistance Publique, Hôpitaux de Paris, 92140 Clamart, France. benjamin.sztrymf@abc.aphp.fr
Souza
R
R
Bertoletti
L
L
Jaïs
X
X
Sitbon
O
O
Price
L C
LC
Simonneau
G
G
Humbert
M
M
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000378:metabolism; D002316:Cardiotonic Agents / Q000008:administration & dosage; D003404:Creatinine / Q000097:blood; D004280:Dobutamine / Q000008:administration & dosage; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology*; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009638:Norepinephrine / Q000008:administration & dosage; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012964:Sodium / Q000097:blood; D016019:Survival Analysis; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D055815:Young Adult
D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents; D020097:Natriuretic Peptide, Brain; D004280:Dobutamine; D002097:C-Reactive Protein; D012964:Sodium; D003404:Creatinine; D009638:Norepinephrine