title: Prediction of true circulatory decompensation in chronic heart failure for optimal timing of mechanical circulatory support: non-invasive arterial-ventricular coupling.
abstract: BACKGROUND
  Prospective comparative studies to predict the risk of hemodynamic deterioration in patients referred for transplantation were performed on the basis of standard invasive and non-invasive data and new wave intensity (WI) parameters.
  
  
  RESULTS
  Study Group 1 consisted of 151 consecutive outpatients (age 48.7 ± 12 years; 110 men) with end-stage dilative cardiomyopathy. Group 2, consisting of 11 consecutive patients (age 50 ± 11 years; 6 men) with sinus rhythm and "true" decompensation, was used to create "critical values" of WI. There were no demographic or somatic (weight and height) differences between the groups. The follow-up period of ambulatory patients was 31 ± 8 months. Non-invasive WI was studied in the common carotid artery. Complete invasive and non-invasive data were also recorded on the day of investigation. During follow-up 44 pts were lost; there were 15 cardiac deaths (10%), life-saving ventricular assist device implantation in 10 (6.6%) and transplantation in 19 (12.7%). For statistical purposes this group was named the "events" Group B (n = 44). A predisposing factor for events (death, "true" decompensation and "urgent" transplantation in ambulatory patients) was low first peak ("cut-off value" assessed in Group 2 < 4100 mmHg*s³) (OR 45.6, CI 14.5-143.3, p < 0.001). Less powerful predictors of the risk of deterioration were pulmonary capillary pressure (PCP), diastolic pulmonary artery pressure (PAP) and E/A mitral wave relation (p = 0.05).
  
  
  CONCLUSIONS
  The new ventricular-arterial coupling parameter 1st peak of WI can potentially be used to distinguish patients at high risk for true deterioration and death. This parameter can be used to predict the need for assist device implantation.
authors: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Augustenburger Platz 1, Berlin 13353, Germany. siniawski@dhzb.de.
authors: Henryk
authors: H
authors: Siniawski
authors: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Augustenburger Platz 1, Berlin 13353, Germany. lehmkuhl@dhzb.de.
authors: Hans
authors: H
authors: Lehmkuhl
authors: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Augustenburger Platz 1, Berlin 13353, Germany. dandel@dhzb.de.
authors: Michael
authors: M
authors: Dandel
authors: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Augustenburger Platz 1, Berlin 13353, Germany. unbehaun@dhzb.de.
authors: Axel
authors: A
authors: Unbehaun
authors: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Augustenburger Platz 1, Berlin 13353, Germany. kemper@dhzb.de.
authors: Dagmar
authors: D
authors: Kemper
authors: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Augustenburger Platz 1, Berlin 13353, Germany. weng@dhzb.de.
authors: Yuguo
authors: Y
authors: Weng
authors: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Augustenburger Platz 1, Berlin 13353, Germany. hetzer@dhzb.de.
authors: Roland
authors: R
authors: Hetzer