title: Hemodynamic responses to rapid saline loading: the impact of age, sex, and heart failure.
abstract: BACKGROUND
  Hemodynamic assessment after volume challenge has been proposed as a way to identify heart failure with preserved ejection fraction. However, the normal hemodynamic response to a volume challenge and how age and sex affect this relationship remain unknown.
  
  
  RESULTS
  Sixty healthy subjects underwent right heart catheterization to measure age- and sex-related normative responses of pulmonary capillary wedge pressure and mean pulmonary arterial pressure to volume loading with rapid saline infusion (100-200 mL/min). Hemodynamic responses to saline infusion in heart failure with preserved ejection fraction (n=11) were then compared with those of healthy young (<50 years of age) and older (≥50 years of age) subjects. In healthy subjects, pulmonary capillary wedge pressure increased from 10±2 to 16±3 mm Hg after ~1 L and to 20±3 mm Hg after ~2 L of saline infusion. Older women displayed a steeper increase in pulmonary capillary wedge pressure relative to volume infused (16±4 mm Hg·L(-1)·m(2)) than the other 3 groups (P≤0.019). Saline infusion resulted in a greater increase in mean pulmonary arterial pressure relative to cardiac output in women compared with men regardless of age. Subjects with heart failure with preserved ejection fraction exhibited a steeper increase in pulmonary capillary wedge pressure relative to infused volume (25±12 mm Hg·L(-1)·m(2)) than healthy young and older subjects (P≤0.005).
  
  
  CONCLUSIONS
  Filling pressures rise significantly with volume loading, even in healthy volunteers. Older women and patients with heart failure with preserved ejection fraction exhibit the largest increases in pulmonary capillary wedge pressure and mean pulmonary arterial pressure.
authors.affiliation: University of Texas Southwestern Medical Center at Dallas.
authors.forename: Naoki
authors.initials: N
authors.lastname: Fujimoto
authors.forename: Barry A
authors.initials: BA
authors.lastname: Borlaug
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Lewis
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Hastings
authors.forename: Keri M
authors.initials: KM
authors.lastname: Shafer
authors.forename: Paul S
authors.initials: PS
authors.lastname: Bhella
authors.forename: Graeme
authors.initials: G
authors.lastname: Carrick-Ranson
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Levine
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D003935:Diagnostic Techniques, Cardiovascular / Q000592:standards*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012016:Reference Values; D012727:Sex Characteristics; D012737:Sex Factors; D012965:Sodium Chloride / Q000008:administration & dosage*; D013318:Stroke Volume / Q000502:physiology; D017725:Ventricular Pressure / Q000502:physiology; D055815:Young Adult
chemical_list: D012965:Sodium Chloride