February 1, 2017Open Access
View Full PaperAortic Waveform Analysis to Individualize Treatment in Heart Failure
Key Result
Aggressive titration of vasoactive therapies in HFrEF showed that higher baseline aortic pressure wave pulsatility and its decrease on treatment were associated with functional improvement (P<0.05).
Structured PICO
Does central aortic waveform analysis predict functional improvement following aggressive titration of vasoactive therapies in patients with HFrEF?
P
Population
38 subjects with heart failure and reduced ejection fraction undergoing aggressive titration of vasoactive therapies.
I
Intervention
Aggressive titration of vasoactive HF therapies with assessment of central aortic waveforms analyzed using pulse wave, wave separation, and arterial reservoir models
O
Outcome
Clinical response to treatment assessed using the 6-minute walk test distancesurrogate
Central aortic waveform analysis, but not conventional brachial cuff pressures, can identify differences in arterial load that predict functional improvement in HFrEF patients undergoing aggressive vasodilator titration.
Main Result
p-value: p=<0.05
Abstract
BACKGROUND: Afterload reduction is a cornerstone in the management of patients with heart failure (HF) and reduced ejection fraction. However, arterial load and the effect of HF therapies on afterload might vary between individuals. Tailoring vasoactive medicines to patients with HF based upon better understanding of arterial afterload may enable better individualization of therapy. METHODS AND RESULTS: Subjects with HF and reduced ejection fraction underwent aggressive titration of vasoactive HF therapies with assessment of central aortic waveforms analyzed using pulse wave, wave separation, and arterial reservoir models. Clinical response to treatment was assessed using the 6-minute walk test distance, which increased in 25 subjects and decreased or remained unchanged in 13. Subjects with improvement on therapy displayed higher aortic pressure wave pulsatility (central pulse pressure PP, reflected pressure wave, and reservoir pressure) at study entry compared with subjects without improvement (all P<0.05). Parameters derived by the arterial analysis methods were strongly correlated with one another and displayed similar ability to predict improvement. Aortic pressure pulsatility significantly decreased in subjects with functional improvement, whereas no change was observed in patients without functional improvement (P for interaction <0.05). These differences in arterial load at baseline and on therapy were not apparent from conventional brachial artery cuff pressure assessments. CONCLUSIONS: Increased aortic pressure wave pulsatility and greater decrease in pulsatility on treatment are associated with functional improvement in patients with HF and reduced ejection fraction receiving aggressive vasodilator titration. These differences are not identifiable using brachial cuff pressures. Central aortic waveform analysis may enable better individualization of vasoactive therapies in chronic HF and reduced ejection fraction. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00588692.