Hocking Kyle M, Huston Jessica, Schmeckpeper Jeffery, Polcz Monica, Case Marisa, Breed Meghan, Vaughn Lexie, Wervey Dawson, Brophy Colleen, Lindenfeld JoAnn, Alvis Bret D
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.
Med Res Arch. 2023 Nov;10(11). doi: 10.18103/mra.v10i11.3276. Epub 2023 Nov 28.
A cornerstone of heart failure assessment is the right heart catheterization and the pulmonary capillary wedge pressure measurement it can provide. Clinical and hemodynamic parameters such as weight and jugular venous distention are less invasive measures often used to diagnose, manage, and treat these patients. To date, there is little data looking at the association of these key parameters to measured pulmonary capillary wedge pressure (PCWP). This is a large, retrospective, secondary analysis of a right heart catheterization database comparing clinical and hemodynamic parameters against measured PCWP in heart failure patients.
A total of 538 subjects were included in this secondary analysis. Spearman's Rho analysis of each clinical and hemodynamic variable was used to compare their association to the documented PCWP. Variables analyzed included weight, body mass index (BMI), jugular venous distention (JVD), creatinine, edema grade, right atrial pressure (RAP), pulmonary artery systolic pressure (PASP), systemic vascular resistance, pulmonary vascular resistance, cardiac output (thermal and Fick), systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, oxygen saturation (SpO), and pulmonary artery diastolic pressure (PADP).
Ten out of 17 selected parameters had a statistically significant association with measured PCWP values. PADP had the strongest association (0.73, p<0.0001), followed by RAP and PASP (0.69, p<0.0001 and 0.67, p<0.0001, respectively). Other significant parameters included weight (0.2, p<0.001), BMI (0.2, p<0.001), SpO (-0.17, p<0.0091), JVD (0.24, p<0.005) and edema grade (0.2, p<0.0001).
This retrospective analysis clarifies the associations of commonly used clinical and hemodynamic parameters to the clinically used gold standard for volume assessment in heart failure patients, PCWP.
心力衰竭评估的基石是右心导管检查及其所能提供的肺毛细血管楔压测量值。体重和颈静脉扩张等临床和血流动力学参数是常用于诊断、管理和治疗这些患者的侵入性较小的指标。迄今为止，几乎没有数据研究这些关键参数与测量的肺毛细血管楔压（PCWP）之间的关联。这是一项对右心导管检查数据库进行的大型回顾性二次分析，比较了心力衰竭患者的临床和血流动力学参数与测量的PCWP。
本次二次分析共纳入538名受试者。对每个临床和血流动力学变量进行Spearman秩相关分析，以比较它们与记录的PCWP之间的关联。分析的变量包括体重、体重指数（BMI）、颈静脉扩张（JVD）、肌酐、水肿分级、右心房压力（RAP）、肺动脉收缩压（PASP）、全身血管阻力、肺血管阻力、心输出量（热稀释法和Fick法）、收缩压、舒张压、心率、呼吸频率、氧饱和度（SpO）和肺动脉舒张压（PADP）。
17个选定参数中有10个与测量的PCWP值存在统计学显著关联。PADP的关联最强（0.73，p<0.0001），其次是RAP和PASP（分别为0.69，p<0.0001和0.67，p<0.0001）。其他显著参数包括体重（0.2，p<0.001）、BMI（0.2，p<0.001）、SpO（-0.17，p<0.0091）、JVD（0.24，p<0.005）和水肿分级（0.2，p<0.0001）。
这项回顾性分析阐明了常用临床和血流动力学参数与心力衰竭患者容量评估的临床金标准PCWP之间的关联。
