title: Hemodynamic factors associated with acute decompensated heart failure: part 1--insights into pathophysiology.
abstract: BACKGROUND
  The purpose of this study was to determine which pressure-based hemodynamic factor was most closely associated with the transition from chronic compensated to acute decompensated heart failure.
  
  
  RESULTS
  Intracardiac pressures were retrospectively examined in 274 heart failure patients using an implantable hemodynamic monitor. The relationship between the development of a heart failure-related event (HFRE) and 3 pressure variables were analyzed: peak estimated pulmonary artery diastolic pressure (ePAD) at the time of an HFRE, change in ePAD from baseline to peak pressure, and the product of ePAD pressure and time (P×T) calculated as the area under the pressure-versus-time curve from baseline to peak pressure. Patients without an HFRE served as control subjects. Peak ePAD and change in ePAD were not closely associated with the development of an HFRE. In patients with an HFRE, P×T was 221 ± 130 mm Hg·days with only 4% of the P×T values <60 mm Hg·days. In contrast, in patients without an HFRE, the P×T was 5 ± 23 with only 4% of the P×T values >60 mm Hg·days.
  
  
  CONCLUSIONS
  The product of small increases in pressure that occur over an extended period of time (P×T) is the pressure-based hemodynamic factor most closely associated with the transition to acute decompensated heart failure.
authors: Division of Cardiology, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA. zilem@musc.edu
authors: Michael R
authors: MR
authors: Zile
authors: Philip B
authors: PB
authors: Adamson
authors: Yong K
authors: YK
authors: Cho
authors: Tom D
authors: TD
authors: Bennett
authors: Robert C
authors: RC
authors: Bourge
authors: Mark F
authors: MF
authors: Aaron
authors: Juan M
authors: JM
authors: Aranda
authors: William T
authors: WT
authors: Abraham
authors: Lynne Warner
authors: LW
authors: Stevenson
authors: Fred J
authors: FJ
authors: Kueffer
mesh_terms: D000208:Acute Disease; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012189:Retrospective Studies