title: Review of ambulatory pulmonary artery catheterization in the management of advanced heart failure.
abstract: The use of pulmonary artery catheterization (PAC) has declined secondary to associated complications and lack of demonstrable efficacy in the inpatient setting. Few studies have been published on the use of PAC in nonacute heart failure (HF) patients. The purpose of this study was to review the use of PAC in guiding advanced therapy in nonacute ambulatory HF patients. A retrospective observational study assessing our group's practice pattern with regard to the use of PAC in 515 ambulatory HF patients, outcomes, and adverse events that resulted from its use was performed. A total of 159 ambulatory HF patients were referred for PAC; 7% underwent heart transplant, 6% had ventricular assist device (VAD) placement, 18% underwent inotropic therapy, and 48% had addition of therapy while 14% had subtraction of therapy. Adverse events occurred in 4% of ambulatory PAC. Patients who underwent heart transplant, VAD, or inotropic therapy had significantly elevated pulmonary capillary wedge pressures, mean pulmonary artery pressures, and depressed cardiac index. Patients selected for inotropic therapy also had significantly elevated right atrial pressures and depressed ejection fractions. PAC use safely guided medical therapy in more than half of the nonacute ambulatory patients.
authors.affiliation: Department of Medicine, Weill Cornell New York Presbyterian Hospital, New York, NY 10065, USA. shm9105@nyp.org
authors.forename: Sharayne
authors.initials: S
authors.lastname: Mark
authors.forename: Pedro
authors.initials: P
authors.lastname: Calderon-Artero
authors.forename: Lisa
authors.initials: L
authors.lastname: Kakinami
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Alexis
authors.forename: Leway
authors.initials: L
authors.lastname: Chen
authors.forename: Eugene
authors.initials: E
authors.lastname: Storozynsky
authors.forename: Michael W
authors.initials: MW
authors.lastname: Fong
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D016022:Case-Control Studies; D002407:Catheterization, Swan-Ganz; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome