Identifying Discordance of Right- and Left-Ventricular Filling Pressures in Patients With Heart Failure by the Clinical Examination
| Autor: | Robert M. Morlend, Alpesh Amin, Colby Ayers, Faris G. Araj, Mark H. Drazner, Sonia Garg, Elizabeth A. Hardin, Jennifer T. Thibodeau, David Pham, Justin L. Grodin, Pradeep P.A. Mammen |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Atrial Pressure Renal function Physical examination Article Ventricular Function Left Ventricular Dysfunction Left Internal medicine Ventricular Pressure medicine Humans In patient Pulmonary Wedge Pressure Physical Examination Heart Failure Ejection fraction medicine.diagnostic_test Venous pressure business.industry Hemodynamics Stroke Volume Middle Aged medicine.disease Heart failure Cardiology Cardiology and Cardiovascular Medicine Ventricular filling business |
| Zdroj: | Circ Heart Fail |
| ISSN: | 1941-3297 1941-3289 |
| Popis: | Background: In ≈25% of patients with heart failure and reduced left-ventricular ejection fraction, right-ventricular (RV), and left-ventricular (LV) filling pressures are discordant (ie, one is elevated while the other is not). Whether clinical assessment allows detection of this discordance is unknown. We sought to determine the agreement of clinically versus invasively determined patterns of ventricular congestion. Methods: In 156 heart failure and reduced LV ejection fraction subjects undergoing invasive hemodynamic assessment, we categorized patterns of ventricular congestion (no congestion, RV only, LV only, or both) based on clinical findings of RV (jugular venous distention) or LV (hepatojugular reflux, orthopnea, or bendopnea) congestion. Agreement between clinically and invasively determined (RV congestion if right atrial pressure [RAP] ≥10 mm Hg and LV congestion if pulmonary capillary wedge pressure [PCWP] ≥22 mm Hg) categorizations was the primary end point. Results: The frequency of clinical patterns of congestion was: 51% no congestion, 24% both RV and LV, 21% LV only, and 4% RV only. Jugular venous distention had excellent discrimination for elevated RAP (C=0.88). However, agreement between clinical and invasive congestion patterns was poor, к=0.44 (95% CI, 0.34–0.55). While those with no clinical congestion usually had low RAP and PCWP (67/79, 85%), over one-half (24/38, 64%) with isolated LV clinical congestion had PCWP Conclusions: While clinical examination allows accurate detection of elevated RAP, it does not allow accurate detection of discordant RV and LV filling pressures. |
| Databáze: | OpenAIRE |
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