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Identifying Discordance of Right- and Left-Ventricular Filling Pressures in Patients With Heart Failure by the Clinical Examination
- Source :
- Circ Heart Fail
- Publication Year :
- 2021
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2021.
-
Abstract
- Background: In ≈25% of patients with heart failure and reduced left-ventricular ejection fraction, right-ventricular (RV), and left-ventricular (LV) filling pressures are discordant (ie, one is elevated while the other is not). Whether clinical assessment allows detection of this discordance is unknown. We sought to determine the agreement of clinically versus invasively determined patterns of ventricular congestion. Methods: In 156 heart failure and reduced LV ejection fraction subjects undergoing invasive hemodynamic assessment, we categorized patterns of ventricular congestion (no congestion, RV only, LV only, or both) based on clinical findings of RV (jugular venous distention) or LV (hepatojugular reflux, orthopnea, or bendopnea) congestion. Agreement between clinically and invasively determined (RV congestion if right atrial pressure [RAP] ≥10 mm Hg and LV congestion if pulmonary capillary wedge pressure [PCWP] ≥22 mm Hg) categorizations was the primary end point. Results: The frequency of clinical patterns of congestion was: 51% no congestion, 24% both RV and LV, 21% LV only, and 4% RV only. Jugular venous distention had excellent discrimination for elevated RAP (C=0.88). However, agreement between clinical and invasive congestion patterns was poor, к=0.44 (95% CI, 0.34–0.55). While those with no clinical congestion usually had low RAP and PCWP (67/79, 85%), over one-half (24/38, 64%) with isolated LV clinical congestion had PCWP Conclusions: While clinical examination allows accurate detection of elevated RAP, it does not allow accurate detection of discordant RV and LV filling pressures.
- Subjects :
- Male
medicine.medical_specialty
Atrial Pressure
Renal function
Physical examination
Article
Ventricular Function, Left
Ventricular Dysfunction, Left
Internal medicine
Ventricular Pressure
medicine
Humans
In patient
Pulmonary Wedge Pressure
Physical Examination
Heart Failure
Ejection fraction
medicine.diagnostic_test
Venous pressure
business.industry
Hemodynamics
Stroke Volume
Middle Aged
medicine.disease
Heart failure
Cardiology
Cardiology and Cardiovascular Medicine
Ventricular filling
business
Subjects
Details
- ISSN :
- 19413297 and 19413289
- Volume :
- 14
- Database :
- OpenAIRE
- Journal :
- Circulation: Heart Failure
- Accession number :
- edsair.doi.dedup.....3e0664c98c10153a6f627fc78ab2787f