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Importance of Venous Congestion for Worsening of Renal Function in Advanced Decompensated Heart Failure
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| 09.03.2009, 15:55 |
Objectives To determine whether venous congestion, rather than impairment of cardiac output, is primarily associated with the
development of worsening renal function (WRF) in patients with advanced decompensated heart failure (ADHF).
Background Reduced cardiac output is traditionally believed to be the main determinant of WRF in patients with ADHF.
Methods A total of 145 consecutive patients admitted with ADHF treated with intensive medical therapy guided by pulmonary
artery catheter were studied. We defined WRF as an increase of serum creatinine 0.3 mg/dl during
hospitalization.
Results In the study cohort (age 57 14 years, cardiac index 1.9 0.6 l/min/m2, left ventricular ejection fraction 20
8%, serum creatinine 1.7 0.9 mg/dl), 58 patients (40%) developed WRF. Patients who developed WRF had a
greater central venous pressure (CVP) on admission (18 7 mm Hg vs. 12 6 mm Hg, p 0.001) and after
intensive medical therapy (11 8 mm Hg vs. 8 5 mm Hg, p 0.04). The development of WRF occurred less
frequently in patients who achieved a CVP 8 mm Hg (p 0.01). Furthermore, the ability of CVP to stratify risk
for development of WRF was apparent across the spectrum of systemic blood pressure, pulmonary capillary
wedge pressure, cardiac index, and estimated glomerular filtration rates.
Conclusions Venous congestion is the most important hemodynamic factor driving WRF in decompensated patients with advanced
heart failure. (J Am Coll Cardiol 2009;53:589–96) © 2009 by the American College of Cardiology
Foundation
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| Категория: Статьи | Добавил: nbylova
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