Lung congestion in chronic heart failure: haemodynamic, clinical, and prognostic implications
Language English Country England, Great Britain Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
26467180
DOI
10.1002/ejhf.417
Knihovny.cz E-resources
- Keywords
- Congestion, Haemodynamics, Heart failure, Pulmonary oedema, Pulmonary vascular resistance, Right heart,
- MeSH
- Survival Analysis MeSH
- Vascular Resistance * MeSH
- Ventricular Dysfunction, Right physiopathology MeSH
- Echocardiography methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Lung diagnostic imaging MeSH
- Pulmonary Edema * blood diagnosis etiology mortality physiopathology MeSH
- Hypertension, Pulmonary * diagnosis etiology physiopathology MeSH
- Prognosis MeSH
- Radiography MeSH
- Respiratory Function Tests methods MeSH
- Retrospective Studies MeSH
- Risk Factors MeSH
- Aged MeSH
- Cardiac Catheterization methods MeSH
- Heart Failure * complications diagnosis physiopathology MeSH
- Statistics as Topic MeSH
- Severity of Illness Index MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- United States MeSH
AIMS: The goal of the study was to examine the prognostic impact, haemodynamic and clinical features associated with lung congestion in patients with chronic heart failure (HF). METHODS AND RESULTS: HF patients (n = 186) and HF-free controls (n = 21) underwent right heart catheterization, echocardiography, pulmonary function testing and chest radiography that was blindly scored for the presence and severity of lung oedema. Lung congestion correlated directly with pulmonary vascular resistance (PVR, P = 0.004) and inversely with pulmonary artery (PA) compliance (P < 0.001) and the diffusion limit for carbon monoxide (DLCO , P = 0.009). Compared with dry lung HF, wet lung HF patients (congestion score > median) had 25% lower PA compliance and 25-35% higher PVR, transpulmonary gradients and PA pressures (40 vs. 32 mmHg, P < 0.001) despite marginally higher PA wedge pressure (PAWP; 22 vs. 19 mmHg, P = 0.002). Wet lung HF patients displayed more right ventricular (RV) dilatation and dysfunction, more restrictive ventilation and greater reduction of DLCO . The strongest correlates of lung congestion were NT-proBNP, haemoglobin, albumin, and glomerular filtration, all surpassing PAWP. After a median of 333 days (interquartile range 80-875), 59 patients (32%) died. Lung congestion was associated with reduced survival (P < 0.0001), even after adjusting for PAWP, NT-proBNP, anaemia, CAD and renal dysfunction. CONCLUSION: Interstitial lung oedema is associated with pulmonary vascular disease, RV overload and dysfunction and increased mortality in HF. These data reinforce the importance of aggressive decongestion in HF and suggest that novel agents aimed at reducing lung water may help to deter progression of pulmonary vascular disease and biventricular HF.
Department of Cardiology Aarhus University Hospital Aarhus Denmark
Department of Cardiology Institute for Clinical and Experimental Medicine IKEM Prague Czech Republic
Division of Cardiovascular Diseases Department of Medicine Mayo Clinic Rochester MN USA
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