PMID- 36001949
OWN - NLM
STAT- MEDLINE
DCOM- 20220826
LR  - 20221026
IS  - 1526-6702 (Electronic)
IS  - 0730-2347 (Print)
IS  - 0730-2347 (Linking)
VI  - 49
IP  - 4
DP  - 2022 Jul 1
TI  - Decongestion Models and Metrics in Acute Heart Failure: ESCAPE Data in the Age of 
      the Implantable Cardiac Pressure Monitor.
LID - 10.14503/THIJ-21-7587 [doi]
LID - e217587
AB  - The United States Food and Drug Administration restricts the use of implantable 
      cardiac pressure monitors to patients with New York Heart Association (NYHA) 
      class III heart failure (HF). We investigated whether single-pressure monitoring 
      could predict survival in HF patients as part of a model constructed using data 
      from the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary 
      Artery Catheterization Effectiveness) trial. We validated survival models in 204 
      patients, using all-cause 180-day mortality. Two levels of model complexity were 
      tested: 1) a simplified 1-pressure model based on pulmonary artery mean pressure 
      ([PAM]1P) (information obtainable from an implanted intracardiac monitor alone), 
      and 2) a pair of 5-variable risk score models based on right atrial pressure 
      (RAP) + pulmonary capillary wedge pressure (PCWP) ([RAP+PCWP]5V) and on RAP + PAM 
      ([RAP+PAM]5V). The more complex models used 5 dichotomous variables: a congestion 
      index above a certain threshold value, baseline systolic blood pressure of <100 
      mmHg, baseline blood urea nitrogen level of >/= 34 mg/dL, need for cardiopulmonary 
      resuscitation or mechanical ventilation, and posttreatment NYHA class IV status. 
      The congestion index was defined as posttreatment RAP+PCWP or posttreatment 
      RAP+PAM, with congestion thresholds of 34 and 42 mmHg, respectively (median 
      pulmonary catheter indwelling time, 1.9 d). The 5-variable models predicted 
      survival with areas under the curve of 0.868 for the (RAP+PCWP)5V model and 0.827 
      for the (RAP+PAM)5V model, whereas the 1-pressure model predicted survival with 
      an area under the curve of 0.718. We conclude that decongestion as determined by 
      hemodynamic assessment predicts survival in HF patients and that it may be the 
      final pathway for treatment benefit despite improvements in pharmacologic 
      intervention since the ESCAPE trial.
CI  - (c) 2022 by the Texas Heart(R) Institute, Houston.
FAU - Paniagua, David
AU  - Paniagua D
AD  - Section of Cardiology, Baylor College of Medicine and Michael E. DeBakey Veterans 
      Affairs Medical Center, Houston, Texas.
AD  - Department of Adult Cardiology, Texas Heart Institute, Houston, Texas.
FAU - Levine, Glenn N
AU  - Levine GN
AD  - Section of Cardiology, Baylor College of Medicine and Michael E. DeBakey Veterans 
      Affairs Medical Center, Houston, Texas.
FAU - Cornwell, Lorraine D
AU  - Cornwell LD
AD  - Section of Thoracic Surgery, Baylor College of Medicine and Michael E. DeBakey 
      Veterans Affairs Medical Center, Houston, Texas.
FAU - Jimenez, Ernesto
AU  - Jimenez E
AD  - Section of Thoracic Surgery, Baylor College of Medicine and Michael E. DeBakey 
      Veterans Affairs Medical Center, Houston, Texas.
FAU - Kar, Biswajit
AU  - Kar B
AD  - Section of Cardiology, Baylor College of Medicine and Michael E. DeBakey Veterans 
      Affairs Medical Center, Houston, Texas.
AD  - The University of Texas Health Science Center at Houston, Houston, Texas.
FAU - Jneid, Hani
AU  - Jneid H
AD  - Section of Cardiology, Baylor College of Medicine and Michael E. DeBakey Veterans 
      Affairs Medical Center, Houston, Texas.
FAU - Denktas, Ali E
AU  - Denktas AE
AD  - Section of Cardiology, Baylor College of Medicine and Michael E. DeBakey Veterans 
      Affairs Medical Center, Houston, Texas.
FAU - Ma, Tony S
AU  - Ma TS
AD  - Section of Cardiology, Baylor College of Medicine and Michael E. DeBakey Veterans 
      Affairs Medical Center, Houston, Texas.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Tex Heart Inst J
JT  - Texas Heart Institute journal
JID - 8214622
SB  - IM
MH  - *Benchmarking
MH  - Cardiac Catheterization
MH  - Clinical Trials as Topic
MH  - *Heart Failure/diagnosis/therapy
MH  - Hemodynamics
MH  - Humans
MH  - Pulmonary Wedge Pressure/physiology
MH  - Risk Factors
PMC - PMC9427063
OTO - NOTNLM
OT  - Acute heart failure/diagnosis/mortality/therapy
OT  - blood pressure monitors
OT  - cardiovascular models
OT  - hemodynamics
OT  - monitoring, physiologic/instrumentation
OT  - risk assessment
OT  - survival
COIS- Conflict of Interest Disclosures: None
EDAT- 2022/08/25 06:00
MHDA- 2022/08/27 06:00
PMCR- 2022/07/01
CRDT- 2022/08/24 18:22
PHST- 2022/08/24 18:22 [entrez]
PHST- 2022/08/25 06:00 [pubmed]
PHST- 2022/08/27 06:00 [medline]
PHST- 2022/07/01 00:00 [pmc-release]
AID - 485300 [pii]
AID - 10.14503/THIJ-21-7587 [doi]
PST - ppublish
SO  - Tex Heart Inst J. 2022 Jul 1;49(4):e217587. doi: 10.14503/THIJ-21-7587.