title: Usefulness of the Sum of Pulmonary Capillary Wedge Pressure and Right Atrial Pressure as a Congestion Index that Prognosticates Heart Failure Survival (from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness Trial).
abstract: In the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial, use of a pulmonary artery catheter did not significantly affect advanced heart failure outcomes. However, the success of achieving the targeted hemodynamic goals of pulmonary capillary wedge pressure (PCWP) of 15 mm Hg and right atrial pressure (RAP) of 8 mm Hg and the association of these goals with clinical outcomes were not addressed. Furthermore, goals with 2 independent variables, PCWP and RAP, left room for uncertainties. We assessed the ability of a single hemodynamic target to achieve a threshold sum of PCWP and RAP as a predictor of all-cause mortality, death-or-transplantation (DT), or death-or-rehospitalization (DR) at 6 months in the pulmonary artery catheter-guided treatment arm of ESCAPE (n = 206). Patients with a posttreatment PCWP + RAP of <30 mm Hg had characteristics similar to those of the population who achieved the ESCAPE hemodynamic goals. This group had 8.7% mortality, 13.0% DT, and 58.7% DR at 6 months. The contrasting cohort with PCWP + RAP of ≥30 mm Hg had 45.3% mortality, 54.7% DT, and 84.9% DR at 6 months, with greater relative risk (RR) of death (RR 5.76), DT (RR 4.92), and DR (RR 1.80) and higher prevalence of jugular venous pulsation, edema, hepatomegaly, and ascites at admission and discharge. In conclusion, PCWP + RAP of 30 mm Hg posttreatment, obtained early in the index hospitalization, may represent as a simple congestion index that has prognostic value for heart failure survival and readmission rates at 6 months and as a warning signal for more aggressive intervention, thus warranting further validation.
authors.affiliation: Section of Cardiology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas. Electronic address: ma_tony@sbcglobal.net.
authors.forename: Tony S
authors.initials: TS
authors.lastname: Ma
authors.affiliation: Section of Cardiology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: David
authors.initials: D
authors.lastname: Paniagua
authors.affiliation: Section of Cardiology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Ali E
authors.initials: AE
authors.lastname: Denktas
authors.affiliation: Section of Cardiology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Hani
authors.initials: H
authors.lastname: Jneid
authors.affiliation: Section of Cardiology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Medical Division, Department of Medicine, Center for Advanced Heart Failure, Memorial Hermann Heart and Vascular Institute Memorial Hermann-Texas Medical Center, Houston, Texas.
authors.forename: Biswajit
authors.initials: B
authors.lastname: Kar
authors.affiliation: Department of Biostatistics, The University of Texas-Health Science Center at Houston, Houston, Texas.
authors.forename: Wenyaw
authors.initials: W
authors.lastname: Chan
authors.affiliation: Section of Cardiology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Winters Center for Heart Failure Research and Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas.
authors.forename: Biykem
authors.initials: B
authors.lastname: Bozkurt
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000453:epidemiology / Q000503:physiopathology; D062185:Atrial Pressure; D006328:Cardiac Catheterization; D002423:Cause of Death; D004487:Edema / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery; D016027:Heart Transplantation; D006529:Hepatomegaly / Q000453:epidemiology / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011379:Prognosis; D011669:Pulmonary Wedge Pressure; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume