PMID- 19907163
OWN - NLM
STAT- MEDLINE
DCOM- 20100304
LR  - 20100113
IS  - 1421-9735 (Electronic)
IS  - 0253-5068 (Linking)
VI  - 29
IP  - 1
DP  - 2010
TI  - Cardiac efficiency improvement after slow continuous ultrafiltration is assessed 
      by beat-to-beat minimally invasive monitoring in congestive heart failure 
      patients: a preliminary report.
PG  - 44-51
LID - 10.1159/000258552 [doi]
AB  - BACKGROUND: We have evaluate the effect of slow continuous ultrafiltration (SCUF) 
      on cardiac output (CO) and other hemodynamic parameters related to the overall 
      performance of the cardiovascular system in patients with congestive heart 
      failure (CHF). Minimally invasive hemodynamic monitoring was performed via the 
      radial artery using a pressure recording analytical method (PRAM) during SCUF 
      treatment. PATIENTS AND METHODS: Using PRAM, hemodynamic changes were assessed in 
      15 CHF patients (New York Heart Association (NYHA) class III-IV) treated with 
      fluid overload removal by ultrafiltration. We analyzed the clinical and 
      hemodynamic data recorded from 6 h before to 36 h after SCUF treatment. RESULTS: 
      Fluid removal was associated with clinical improvements, reductions in weight 
      (7.4%, p < 0.01), edema and dyspnea, increased response to diuretics, and 
      reductions in NYHA class (3.5 +/- 0.52 to 2.4 +/- 0.63, p < 0.01) and plasma 
      pro-B-type natriuretic peptide (BNP) levels (21,810 +/- 13,016 to 8,581 +/- 5,549 
      pg/ml, p < 0.05). Clinical improvement was associated with significant variations 
      in stroke volume (+17%, p < 0.05), CO (+19%, p < 0.05), cardiac power output 
      (+19%, p < 0.05), dP/dt(max) (+49%, p < 0.01), cardiac cycle efficiency (CCE; 
      +0.44 units, p < 0.01), systemic vascular resistances (SVR; -12%, p < 0.05) and 
      dicrotic pressure (-10%, p < 0.05) with respect to their baseline values. No 
      significant variations in heart rate, and systolic and mean blood pressure were 
      observed. Pro-BNP levels were found to correlate positively with both SVR (r = 
      0.96, p = 0.002) and NYHA class (r = 0.96, p = 0.037) and negatively with 
      dP/dt(max) (r = -0.83, p = 0.039), CCE (r = -0.93, p = 0.011) and CO (r = -0.94, 
      p = 0.014). CONCLUSIONS: In CHF patients, ultrafiltration improves not only CO, 
      as previously reported, but also contractile cardiac efficiency and performance. 
      The PRAM system, a minimally invasive method, was able to record hemodynamic 
      changes during SCUF treatment.
CI  - Copyright 2009 S. Karger AG, Basel.
FAU - Giglioli, Cristina
AU  - Giglioli C
AD  - Department of Cardiac and Vascular Sciences, University of Florence, Florence, 
      Italy.
FAU - Landi, Daniele
AU  - Landi D
FAU - Gensini, Gian Franco
AU  - Gensini GF
FAU - Valente, Serafina
AU  - Valente S
FAU - Cecchi, Emanuele
AU  - Cecchi E
FAU - Scolletta, Sabino
AU  - Scolletta S
FAU - Chiostri, Marco
AU  - Chiostri M
FAU - Romano, Salvatore M
AU  - Romano SM
LA  - eng
PT  - Journal Article
DEP - 20091112
PL  - Switzerland
TA  - Blood Purif
JT  - Blood purification
JID - 8402040
RN  - 0 (Diuretics)
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
SB  - IM
MH  - Aged, 80 and over
MH  - Blood Pressure/physiology
MH  - Cardiac Output
MH  - Diuretics/therapeutic use
MH  - Edema/therapy
MH  - Heart Failure/*physiopathology/therapy
MH  - Heart Rate
MH  - Hemodynamics/*physiology
MH  - Hemofiltration/*methods
MH  - Humans
MH  - Monitoring, Physiologic/*methods
MH  - Natriuretic Peptide, Brain
MH  - Pilot Projects
MH  - Treatment Outcome
MH  - Vascular Resistance
EDAT- 2009/11/13 06:00
MHDA- 2010/03/05 06:00
CRDT- 2009/11/13 06:00
PHST- 2009/05/28 00:00 [received]
PHST- 2009/08/07 00:00 [accepted]
PHST- 2009/11/13 06:00 [entrez]
PHST- 2009/11/13 06:00 [pubmed]
PHST- 2010/03/05 06:00 [medline]
AID - 000258552 [pii]
AID - 10.1159/000258552 [doi]
PST - ppublish
SO  - Blood Purif. 2010;29(1):44-51. doi: 10.1159/000258552. Epub 2009 Nov 12.