September 10, 2019
View Full PaperHemodynamic assessment in heart failure
Key Result
Hemodynamic assessment in the catheterization laboratory provides actionable insights into volume status and cardiac function to guide therapy optimization in heart failure.
Structured PICO
P
Population
Three cases illustrating the use of hemodynamic assessment to guide optimization of therapy in patients with heart failure.
I
Intervention
Hemodynamic assessment in the cardiac catheterization laboratory
O
Outcome
Optimization of hemodynamic status
Hemodynamic assessment in the catheterization laboratory is a valuable tool for understanding and optimizing the complex interplay of cardiac ejection and filling in heart failure patients.
Abstract
Hemodynamics play a central role in the pathophysiology of heart failure (HF), yet their proper assessment and optimization remains challenging. Heart failure is defined as the inability of the heart to deliver adequate perfusion (cardiac output) to the body at rest or exercise, or to require an elevation in cardiac filling pressures in order to do this. This bedrock definition is important because it relies on measurable quantities (filling pressures and output) that are readily assessed in the cardiac catheterization laboratory. Here we present three cases to illustrate how better understanding of the determinants of cardiac output and stroke volume: preload, afterload, contractility, and lusitropy, as well as the determinants of congestion (high filling pressures) may be used to guide optimization of hemodynamic status. The goal is that the readers will be able to think more critically when evaluating the hemodynamics of their patient in HF and recognize the complex interplay that determines the complex balance between cardiac ejection and filling capabilities, and how this alters symptoms and outcomes for patients with HF. KEY POINTS: Careful assessment of hemodynamics in the catheterization laboratory allows for actionable insight to a patient's volume status, cardiac function and can help prognosticate outcomes. Exercise hemodynamics in heart failure is a powerful tool to better understand the cause of symptoms and predict outcomes. Clinicians should aim to decrease biventricular filling pressures to normal values to improve morbidity and reduce risk for readmission. In patients with heart failure and reduced ejection fraction, clinicians should aim to decrease afterload as much as can be tolerated by the renal function and patient's symptoms. Low cardiac output can often be improved by optimizing preload and afterload rather than initiating inotropes, which should be reserved until needed. In advanced heart failure, the right heart function becomes a key determinant of symptoms and outcomes.
Cite This Study
Jain et al. (Tue,) conducted a review in Heart failure (n=3). Hemodynamic assessment was evaluated. Hemodynamic assessment in the catheterization laboratory provides actionable insights into volume status and cardiac function to guide therapy optimization in heart failure.