Copyright © 2002 by the European Society of Cardiology.
Continous haemodynamic monitoring during withdrawal of diuretics in patients with congestive heart failure
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 Furosemide, the only diuretic used, was reduced by 50% the first week, withdrawn completely for the second week and then reinstituted in the initial dose.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.
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