title: Baseline Hemodynamics and Response to Contrast Media During Diagnostic Cardiac Catheterization Predict Adverse Events in Heart Failure Patients.
abstract: Contrast media administered during cardiac catheterization can affect hemodynamic variables. However, little is documented about the effects of contrast on hemodynamics in heart failure patients or the prognostic value of baseline and changes in hemodynamics for predicting subsequent adverse events.
  
  
  
  In this prospective study of 150 heart failure patients, we measured hemodynamics at baseline and after administration of iodixanol or iopamidol contrast. One-year Kaplan-Meier estimates of adverse event-free survival (death, heart failure hospitalization, and rehospitalization) were generated, grouping patients by baseline measures of pulmonary capillary wedge pressure (PCWP) and cardiac index (CI), and by changes in those measures after contrast administration. We used Cox proportional hazards modeling to assess sequentially adding baseline PCWP and change in CI to 5 validated risk models (Seattle Heart Failure Score, ESCAPE [Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness], CHARM [Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity], CORONA [Controlled Rosuvastatin Multinational Trial in Heart Failure], and MAGGIC [Meta-Analysis Global Group in Chronic Heart Failure]). Median contrast volume was 109 mL. Both contrast media caused similarly small but statistically significant changes in most hemodynamic variables. There were 39 adverse events (26.0%). Adverse event rates increased using the composite metric of baseline PCWP and change in CI (P<0.01); elevated baseline PCWP and decreased CI after contrast correlated with the poorest prognosis. Adding both baseline PCWP and change in CI to the 5 risk models universally improved their predictive value (P≤0.02).
  
  
  
  In heart failure patients, the administration of contrast causes small but significant changes in hemodynamics. Calculating baseline PCWP with change in CI after contrast predicts adverse events and increases the predictive value of existing models. Patients with elevated baseline PCWP and decreased CI after contrast merit greatest concern.
authors.affiliation: From the Division of Cardiovascular Medicine, Duke University Medical Center (S.J.D., J.E.T., C.M.O.) and Duke Clinical Research Institute (S.J.D., D.M.V., J.E.T., C.M.O.), Durham, NC; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis (D.M.V.); Section of Cardiology, North Florida/South Georgia Veterans Affairs, Gainesville, FL (C.M.S.); and Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (G.D.Y.). scott.denardo@duke.edu.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Denardo
authors.affiliation: From the Division of Cardiovascular Medicine, Duke University Medical Center (S.J.D., J.E.T., C.M.O.) and Duke Clinical Research Institute (S.J.D., D.M.V., J.E.T., C.M.O.), Durham, NC; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis (D.M.V.); Section of Cardiology, North Florida/South Georgia Veterans Affairs, Gainesville, FL (C.M.S.); and Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (G.D.Y.).
authors.forename: David M
authors.initials: DM
authors.lastname: Vock
authors.affiliation: From the Division of Cardiovascular Medicine, Duke University Medical Center (S.J.D., J.E.T., C.M.O.) and Duke Clinical Research Institute (S.J.D., D.M.V., J.E.T., C.M.O.), Durham, NC; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis (D.M.V.); Section of Cardiology, North Florida/South Georgia Veterans Affairs, Gainesville, FL (C.M.S.); and Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (G.D.Y.).
authors.forename: Carsten M
authors.initials: CM
authors.lastname: Schmalfuss
authors.affiliation: From the Division of Cardiovascular Medicine, Duke University Medical Center (S.J.D., J.E.T., C.M.O.) and Duke Clinical Research Institute (S.J.D., D.M.V., J.E.T., C.M.O.), Durham, NC; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis (D.M.V.); Section of Cardiology, North Florida/South Georgia Veterans Affairs, Gainesville, FL (C.M.S.); and Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (G.D.Y.).
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Young
authors.affiliation: From the Division of Cardiovascular Medicine, Duke University Medical Center (S.J.D., J.E.T., C.M.O.) and Duke Clinical Research Institute (S.J.D., D.M.V., J.E.T., C.M.O.), Durham, NC; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis (D.M.V.); Section of Cardiology, North Florida/South Georgia Veterans Affairs, Gainesville, FL (C.M.S.); and Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (G.D.Y.).
authors.forename: James E
authors.initials: JE
authors.lastname: Tcheng
authors.affiliation: From the Division of Cardiovascular Medicine, Duke University Medical Center (S.J.D., J.E.T., C.M.O.) and Duke Clinical Research Institute (S.J.D., D.M.V., J.E.T., C.M.O.), Durham, NC; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis (D.M.V.); Section of Cardiology, North Florida/South Georgia Veterans Affairs, Gainesville, FL (C.M.S.); and Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (G.D.Y.).
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002302:Cardiac Output / Q000187:drug effects; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007479:Iopamidol / Q000008:administration & dosage / Q000009:adverse effects*; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014283:Triiodobenzoic Acids / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol; D007479:Iopamidol
keywords: cardiac catheterization; contrast media; heart failure; hemodynamics; prognosis