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European Heart Journal 2002 23(1):59-69; doi:10.1053/euhj.2001.2690
Copyright © 2002 by the European Society of Cardiology.
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Continous haemodynamic monitoring during withdrawal of diuretics in patients with congestive heart failure

F. Braunschweiga,f1, C. Lindea, M.J. Erikssonb, C. Hofman-Banga and L. Rydéna

a Department of Cardiology, Karolinska Hospital, Stockholm, Sweden
b Department of Clinical Physiology, Karolinska Hospital, Stockholm, Sweden

revised March 14, 2001; accepted March 21, 2001

Abstract

Aims Right heart pressure parameters can be recorded continuously with the help of an implanted haemodynamic monitor. The aim of this study was to investigate the usefulness of the device in adjusting diuretic medication in patients with chronic congestive heart failure, and to evaluate the response of right ventricular pressure to increased volume load induced by diuretic withdrawal.

Methods and Results Four patients with stable congestive heart failure were implanted with an implantable haemodynamic monitor. Furosemide, the only diuretic used, was reduced by 50% the first week, withdrawn completely for the second week and then reinstituted in the initial dose. Right ventricular systolic and diastolic pressure, pulse pressure, dP/dt, estimated diastolic pulmonary artery pressure and heart rate were sampled continuously. Patients were evaluated by body weight, NYHA class, serum creatinine, serum brain natriuretic peptide, the 6min walk test, quality of life and echocardiography on days 0, 7, 14 and 21. We observed significant changes in right ventricular pressure parameters in parallel with clinical signs and symptoms of worsening heart failure, such as increased body weight, a shorter walking distance and impaired quality of life. Moreover elevated levels of brain natriuretic peptide and lower creatinine levels were observed.

Conclusion Haemodynamic changes due to increased volume load can be detected with an implantable haemodynamic monitor. Such data provide useful information for tailoring an optimal diuretic dose in patients with congestive heart failure.

Key Words: Haemodynamic monitoring, ambulatory, congestive heart failure, therapy, loop diuretics

f1 Correspondence: Frieder Braunschweig MD, Department of Cardiology, Karolinska Hospital, S-17176 Stockholm, Sweden.

References

  1. Ohlsson A, Bennett T, Nordlander R, Rydén J, Astrom H, Rydén L. Monitoring of pulmonary arterial diastolic pressure through a right ventricular pressure transducer. J Card Fail. 1995;1:161–168[CrossRef][Medline]
  2. Ohlsson A, Nordlander R, Bennett T. Continuous ambulatory haemodynamic monitoring with an implantable system. The feasibility of a new technique. Eur Heart J. 1998;19:174–184[Abstract/Free Full Text]
  3. Steinhaus DM, Lemery R, Bresnahan DR Jr.. Initial experience with an implantable hemodynamic monitor. Circulation. 1996;93:745–752[Abstract/Free Full Text]
  4. Ohlsson, , Kubo, SH, Steinhaus, D, Continuous ambulatory monitoring of absolute right ventricular pressure and mixed venous oxygen saturation in patients with heart failure using an implantable hemodynamic monitor: results of a one year multicenter feasibility study, Eur Heart J
  5. Young JB, Weiner DH, Yusuf S. Patterns of medication use in patients with heart failure: a report from the Registry of Studies of Left Ventricular Dysfunction (SOLVD). South Med J. 1995;88:514–523[ISI][Medline]
  6. Stewart RB, Moore MT, May FE, Marks RG, Hale WE. A longitudinal evaluation of drug use in an ambulatory elderly population. J Clin Epidemiol. 1991;44:1353–1359[CrossRef][ISI][Medline]
  7. Chrischilles EA, Foley DJ, Wallace RB. Use of medications by persons 65 and over: data from the established populations for epidemiologic studies of the elderly. J Gerontol. 1992;47:M137–144[ISI][Medline]
  8. Bayliss J, Norell M, Canepa-Anson R, Sutton G, Poole-Wilson P. Untreated heart failure: clinical and neuroendocrine effects of introducing diuretics. Br Heart J. 1987;57:17–22[Abstract/Free Full Text]
  9. Cleland JG, Swedberg K, Poole-Wilson PA. Successes and failures of current treatment of heart failure. Lancet. 1998;352:SI19–28
  10. Grinstead WC, Francis MJ, Marks GF, Tawa CB, Zoghbi WA, Young JB. Discontinuation of chronic diuretic therapy in stable congestive heart failure secondary to coronary artery disease or to idiopathic dilated cardiomyopathy. Am J Cardiol. 1994;73:881–886[CrossRef][ISI][Medline]
  11. Bennett T, Sharma A, Sutton R, Camm AJ, Erickson M, Beck R. Development of a rate adaptive pacemaker based on the maximum rate-of-rise of right ventricular pressure (RV dP/dtmax). PACE. 1992;15:219–234
  12. Reynolds DW, Bartelt N, Taepke R, Bennett TD. Measurement of pulmonary artery diastolic pressure from the right ventricle. J Am Coll Cardiol. 1995;25:1176–1182[Abstract]
  13. Chuang PP, Wilson RF, Homans DC. Measurement of pulmonary artery diastolic pressure from a right ventricular pressure transducer in patients with heart failure. J Card Fail. 1996;2:41–46[CrossRef][Medline]
  14. Rector TS, Kubo SH, Cohn JH. Patients self-assessment of their heart failure: content, reliability and validity of a new measure, the Minnesota Living with Heart Failure Questionnaire. Heart Failure. 1987;:198–209
  15. Lipkin DP, Scriven AJ, Crake T, Poole-Wilson PA. Six minute walking test for assessing exercise capacity in chronic heart failure. Br Med J (Clin Res Ed). 1986;292:653–655
  16. Zugck C, Kruger C, Durr S. Is the 6-minute walk test a reliable substitute for peak oxygen uptake in patients with dilated cardiomyopathy? Eur Heart J. 2000;21:540–549[Abstract/Free Full Text]
  17. Schiller NB, Shah PM, Crawford M. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989;2:358–367[Medline]
  18. Hammarstrom E, Wranne B, Pinto FJ, Puryear J, Popp RL. Tricuspid annular motion. J Am Soc Echocardiogr. 1991;4:131–139[Medline]
  19. Skjaerpe T, Hegrenaes L, Hatle L. Noninvasive estimation of valve area in patients with aortic stenosis by Doppler ultrasound and two-dimensional echocardiography. Circulation. 1985;72:810–818[Abstract/Free Full Text]
  20. Oh JK, Seward JB, Tajik AJ. Assessment of diastolic function. The Echo Manual. : Lippincott, Williams & Wilkins; 1999. p. 45–57
  21. Walma EP, Hoes AW, van Dooren C, Prins A, van der Does E. Withdrawal of long-term diuretic medication in elderly patients: a double blind randomised trial. BMJ. 1997;315:464–468[Abstract/Free Full Text]
  22. Anand IS, Veall N, Kalra GS. Treatment of heart failure with diuretics: body compartments, renal function and plasma hormones. Eur Heart J. 1989;10:445–450[Abstract/Free Full Text]
  23. Yoshimura M, Yasue H, Okumura K. Different secretion patterns of atrial natriuretic peptide and brain natriuretic peptide in patients with congestive heart failure. Circulation. 1993;87:464–469[Abstract/Free Full Text]
  24. Arakawa N, Nakamura M, Aoki H, Hiramori K. Plasma brain natriuretic peptide concentrations predict survival after acute myocardial infarction. J Am Coll Cardiol. 1996;27:1656–1661[Abstract]
  25. Wallen T, Landahl S, Hedner T, Nakao K, Saito Y. Brain natriuretic peptide predicts mortality in the elderly. Heart. 1997;77:264–267[Abstract/Free Full Text]
  26. Murdoch DR, McDonagh TA, Byrne J. Titration of vasodilator therapy in chronic heart failure according to plasma brain natriuretic peptide concentration: randomized comparison of the hemodynamic and neuroendocrine effects of tailored versus empirical therapy. Am Heart J. 1999;138:1126–1132[CrossRef][ISI][Medline]
  27. Johansson K, Dahlström U, Karlberg K-E, Karlsson E, Nyquist, Nylander E. The value of repeated echocardiographic evaluation in patients with idiopathic dilated cardiomyopathy during treatment with metoprolol or captopril. Scand Cardiovasc J. 2000;34:293–300[ISI][Medline]

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