LETTER TO THE EDITOR
Hemodynamic profiles in heart failure patients
Gregg S. Pressman, MD, FACC
Heart Institute at St. Francis Medical Center, 601 Hamilton Avenue, Trenton, New Jersey 08629, USA
gsp{at}tccdocs.com
I read with great interest the study by Nohria et al. (1) regarding clinical assessment for estimation of hemodynamic profiles in heart failure patients. I compliment the investigators for coming up with a practical index that can be easily applied by clinicians with even modest experience in heart failure. Those of us in clinical practice make similar qualitative assessments daily. Having available a standardized instrument would be very useful when approaching diagnosis and treatment of heart failure patients.
I note that their "profile L" ("dry-cold" patients) represented a limited number of subjects and was not able to be analyzed statistically. The researchers suggest that these patients have "significantly reduced cardiac reserve with a decreased tendency toward congestion" or that this group might include "patients with severely dilated ventricles and anatomic mitral regurgitation who developed symptoms with minimal exertion." I wonder if they have any hemodynamic or Doppler echocardiographic data to support these assertions. Perhaps some of these patients actually had a low cardiac output state due to intravascular depletion, with subsequent reduction in contractile force via Starling mechanisms.
Also, given the wealth of literature showing the prognostic usefulness of diastolic filling patterns on Doppler echocardiography in patients with heart failure (2), I wonder whether these parameters were assessed. Further, does the clinical index advanced by the investigators correlate with Doppler patterns of diastolic filling and does it provide additional prognostic value?
I believe the proposed classification would be very useful clinically when more widely validated and correlated with existing clinical tools.
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References
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1. Nohria A, Tsang SW, Fang JC, et al. Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. J Am Coll Cardiol. 2003;41:1797–1804[Abstract/Free Full Text]
2. Whalley GA, Doughty RN, Gamble GD, et al. Pseudonormal mitral filling pattern predicts hospital re-admission in patients with congestive heart failure. J Am Coll Cardiol. 2002;39:1787–1795[Abstract/Free Full Text]
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