Central venous pressure at emergency room presentation predicts cardiac rehospitalization in patients with decompensated heart failure.
OBJECTIVE
To investigate the relationship between central venous pressure (CVP) at presentation to the emergency room (ER) and the risk of cardiac rehospitalization and mortality in patients with decompensated heart failure (DHF).


RESULTS
Central venous pressure was determined non-invasively using high-resolution compression sonography at presentation in 100 patients with DHF. Cardiac hospitalizations and cardiac and all-cause mortality were assessed as a function of continuous CVP levels and predefined CVP categories (low <6 cm H(2)O, intermediate 6-23 cm H(2)O, and high >23 cm H(2)O). Endpoints were adjudicated blinded to CVP. At presentation, mean age was 78 +/- 11 years, 60% of patients were male, mean B-type natriuretic peptide level was 1904 +/- 1592 pg/mL, and mean CVP was 13.7 +/- 7.0 cm H(2)O (range 0-33). During follow-up (median 12 months), 25 cardiac rehospitalizations, 26 cardiac deaths, and 7 non-cardiac deaths occurred. Univariate and stepwise multivariate Cox regression analysis revealed an independent relationship between CVP and cardiac rehospitalization (HR 1.09, 95% CI 1.01-1.18, P = 0.034). Kaplan-Meier analyses confirmed a stepwise increase in cardiac rehospitalization for low-to-high CVP (log-rank test P = 0.015). No association between CVP and (cardiac) mortality was detectable.


CONCLUSIONS
Central venous pressure at ER presentation in patients with DHF is an independent predictor of cardiac rehospitalization but not of cardiac and all-cause mortality.
Department of Angiology, University Hospital, Basel, Switzerland.
Heiko
H
Uthoff
Christoph
C
Thalhammer
Mihael
M
Potocki
Tobias
T
Reichlin
Markus
M
Noveanu
Markus
M
Aschwanden
Daniel
D
Staub
Nisha
N
Arenja
Thenral
T
Socrates
Raphael
R
Twerenbold
Sarah
S
Mutschmann-Sanchez
Corinna
C
Heinisch
Kurt A
KA
Jaeger
Alexandre
A
Mebazaa
Christian
C
Mueller
D000368:Aged; D000369:Aged, 80 and over; D002496:Central Venous Pressure; D016001:Confidence Intervals; D004417:Dyspnea; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005060:Europe; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain