PMID- 16360968
OWN - NLM
STAT- MEDLINE
DCOM- 20060330
LR  - 20131121
IS  - 1071-9164 (Print)
IS  - 1071-9164 (Linking)
VI  - 11
IP  - 9
DP  - 2005 Dec
TI  - The utility of microvascular perfusion assessment in heart failure: a pilot 
      study.
PG  - 713-9
AB  - BACKGROUND: The evaluation of heart failure is routinely based on subjective 
      patient symptoms and physician examination. We propose the noninvasive evaluation 
      of microvascular and global perfusion can objectify heart failure severity and 
      provide additional prognostic information. METHODS: A prospective, observational 
      pilot study of patients previously stratified into New York Heart Association 
      (NYHA) heart failure classes and who after a routine cardiology clinic evaluation 
      were felt to be at their stable baseline state. Measurements included: thoracic 
      impedance (Zo), hypothenar tissue hemoglobin oxygen saturation (StO2), and 
      Zo-derived cardiac index (CI). To determine if adverse outcomes (hospitalization 
      or death) occurred, patients or their families were contacted 6 months after 
      enrollment and their charts reviewed. Monitor values between the NYHA classes 
      were compared using analysis of variance. Values of those who later developed 
      adverse outcomes were compared to patients who remained stable using a Student 
      t-test (P < .05 considered significant). A Kaplan-Meier survival curve was used 
      to describe the adverse outcome rate over time, and a Cox's proportional hazards 
      model was used to relate perfusion values to adverse outcomes. RESULTS: There 
      were no differences in CI (P = .08), Zo (P = .38), or StO2 (P = .14) found 
      between NYHA classes (n = 46). After 6 months, 6 patients required 
      hospitalization for heart failure and 1 died. This group had lower StO2 values 
      compared with the stable group (P = .015). The time course of the adverse events 
      was found not to be due to chance alone when evaluated using a Kaplan-Meier curve 
      and the StO2 was significantly associated with time to adverse outcome (P < .05). 
      CONCLUSIONS: Outpatient heart failure patients who later develop adverse outcomes 
      have significantly lower StO2 values than those who remain stable. This suggests 
      cardiac performance in stable heart failure patients may be better reflected at 
      the microvascular level using measures such as StO2 as opposed to a global level 
      using the physical exam or impedance cardiography. StO2 may serve as a predictor 
      for future adverse events and as an adjunct to current evaluation techniques.
FAU - Hogan, Christopher J
AU  - Hogan CJ
AD  - Department of Emergency Medicine, VCU Reanimation Engineering Shock Center 
      (VCURES), Virginia Commonwealth University Medical Center, Richmond, Virginia 
      23298-0401, USA.
FAU - Hess, Michael L
AU  - Hess ML
FAU - Ward, Kevin R
AU  - Ward KR
FAU - Gennings, Chris
AU  - Gennings C
LA  - eng
PT  - Journal Article
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - United States
TA  - J Card Fail
JT  - Journal of cardiac failure
JID - 9442138
RN  - S88TT14065 (Oxygen)
SB  - IM
MH  - Adult
MH  - Cardiography, Impedance
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/diagnosis/*physiopathology
MH  - Humans
MH  - Male
MH  - Microcirculation/*physiopathology
MH  - Middle Aged
MH  - Oxygen/metabolism
MH  - Pilot Projects
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Survival Analysis
EDAT- 2005/12/20 09:00
MHDA- 2006/03/31 09:00
CRDT- 2005/12/20 09:00
PHST- 2004/12/13 00:00 [received]
PHST- 2005/06/09 00:00 [revised]
PHST- 2005/07/14 00:00 [accepted]
PHST- 2005/12/20 09:00 [pubmed]
PHST- 2006/03/31 09:00 [medline]
PHST- 2005/12/20 09:00 [entrez]
AID - S1071-9164(05)00702-5 [pii]
AID - 10.1016/j.cardfail.2005.07.005 [doi]
PST - ppublish
SO  - J Card Fail. 2005 Dec;11(9):713-9. doi: 10.1016/j.cardfail.2005.07.005.