Aortic Waveform Analysis to Individualize Treatment in Heart Failure
Language English Country United States Media print
Document type Journal Article, Randomized Controlled Trial
Grant support
R01 HL128526
NHLBI NIH HHS - United States
PubMed
28159826
PubMed Central
PMC5308883
DOI
10.1161/circheartfailure.116.003516
PII: CIRCHEARTFAILURE.116.003516
Knihovny.cz E-resources
- Keywords
- aorta, arterial pressure, blood pressure, heart failure, heart rate,
- MeSH
- Pulse Wave Analysis MeSH
- Aorta drug effects physiopathology MeSH
- Arterial Pressure drug effects MeSH
- Time Factors MeSH
- Chronic Disease MeSH
- Walking MeSH
- Ventricular Function, Left drug effects MeSH
- Single-Blind Method MeSH
- Middle Aged MeSH
- Humans MeSH
- Recovery of Function MeSH
- Pilot Projects MeSH
- Pulsatile Flow drug effects MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Heart Failure diagnosis drug therapy physiopathology MeSH
- Stroke Volume drug effects MeSH
- Exercise Tolerance drug effects MeSH
- Vascular Stiffness drug effects MeSH
- Vasodilator Agents adverse effects therapeutic use MeSH
- Treatment Outcome MeSH
- Exercise Test MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
- Geographicals
- Minnesota MeSH
- Names of Substances
- Vasodilator Agents MeSH
BACKGROUND: Afterload reduction is a cornerstone in the management of patients with heart failure (HF) and reduced ejection fraction. However, arterial load and the effect of HF therapies on afterload might vary between individuals. Tailoring vasoactive medicines to patients with HF based upon better understanding of arterial afterload may enable better individualization of therapy. METHODS AND RESULTS: Subjects with HF and reduced ejection fraction underwent aggressive titration of vasoactive HF therapies with assessment of central aortic waveforms analyzed using pulse wave, wave separation, and arterial reservoir models. Clinical response to treatment was assessed using the 6-minute walk test distance, which increased in 25 subjects and decreased or remained unchanged in 13. Subjects with improvement on therapy displayed higher aortic pressure wave pulsatility (central pulse pressure [PP], reflected pressure wave, and reservoir pressure) at study entry compared with subjects without improvement (all P<0.05). Parameters derived by the arterial analysis methods were strongly correlated with one another and displayed similar ability to predict improvement. Aortic pressure pulsatility significantly decreased in subjects with functional improvement, whereas no change was observed in patients without functional improvement (P for interaction <0.05). These differences in arterial load at baseline and on therapy were not apparent from conventional brachial artery cuff pressure assessments. CONCLUSIONS: Increased aortic pressure wave pulsatility and greater decrease in pulsatility on treatment are associated with functional improvement in patients with HF and reduced ejection fraction receiving aggressive vasodilator titration. These differences are not identifiable using brachial cuff pressures. Central aortic waveform analysis may enable better individualization of vasoactive therapies in chronic HF and reduced ejection fraction. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00588692.
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Arterial Stiffening With Exercise in Patients With Heart Failure and Preserved Ejection Fraction
ClinicalTrials.gov
NCT00588692