From the Department of Cardiovascular Medicine, Cleveland Clinic, OH (B.W.S., M.Y., S.K., W.H.W.T., M.H.); and Department of Cardiovascular Medicine, Massachusetts General Hospital, Boston (J.C.).
Circ Heart Fail. 2017 Jul;10(7). doi: 10.1161/CIRCHEARTFAILURE.117.004130.
Accurate assessment of volume status is essential in diagnosis and guidance of decongestive therapy in patients with acute heart failure. We sought to compare peripheral venous pressure (PVP) with central venous pressure (CVP), as well as other invasive hemodynamic measurements, in patients hospitalized with an acute heart failure syndrome.
PVP-HF (Peripheral Venous Pressure Measurements in Patients With Acute Decompensated Heart Failure) was a single-center prospective study, which enrolled patients admitted with acute heart failure, regardless of ejection fraction or disease pathogenesis. PVP and intracardiac pressures were obtained by transducing a peripheral intravenous and pulmonary artery catheter, respectively, after zeroing at the phlebostatic axis. Data were compared using Pearson's correlation coefficient and Bland-Altman plots. A total of 30 patients (median age 64 years, 73% male, 30% ischemic pathogenesis) were enrolled. Mean ejection fraction was 31%, and 60% had moderate or greater right ventricular dysfunction. Median PVP was 9.5 (6-17) mm Hg, CVP was 8.5 (6-18) mm Hg, and pulmonary capillary wedge pressure was 18 (14-21) mm Hg. PVP and CVP were found to be highly correlated (=0.947), while PVP and pulmonary capillary wedge pressure were found to be moderately correlated (=0.565). The mean difference between PVP and CVP was 0.4 mm Hg and between PVP and pulmonary capillary wedge pressure was 7.5 mm Hg.
In patients with acute heart failure syndromes, a simple assessment of PVP demonstrates a high correlation with CVP. These findings suggest that PVP may be useful in the standard bedside clinical assessment of volume status in these patients to help guide decongestive therapy.
准确评估容量状态对于急性心力衰竭患者的诊断和指导利尿治疗至关重要。我们旨在比较外周静脉压（PVP）与中心静脉压（CVP）以及其他侵入性血流动力学测量值，以评估其在急性心力衰竭综合征患者中的应用。
PVP-HF（急性失代偿性心力衰竭患者外周静脉压测量）是一项单中心前瞻性研究，共纳入因急性心力衰竭入院的患者，无论射血分数或疾病发病机制如何。通过在静脉压零点处分别转换外周静脉和肺动脉导管来获得 PVP 和心内压。使用 Pearson 相关系数和 Bland-Altman 图比较数据。共纳入 30 例患者（中位年龄 64 岁，73%为男性，30%为缺血性发病机制）。平均射血分数为 31%，60%患者存在中度或重度右心室功能障碍。PVP 的中位数为 9.5（6-17）mmHg，CVP 为 8.5（6-18）mmHg，肺毛细血管楔压为 18（14-21）mmHg。PVP 与 CVP 高度相关（=0.947），而 PVP 与肺毛细血管楔压中度相关（=0.565）。PVP 与 CVP 之间的平均差值为 0.4mmHg，PVP 与肺毛细血管楔压之间的平均差值为 7.5mmHg。
在急性心力衰竭综合征患者中，简单评估 PVP 与 CVP 高度相关。这些发现提示 PVP 可能有助于指导利尿治疗，从而在标准床旁临床评估这些患者的容量状态方面发挥作用。
