Heart Care Info - Heart Disease Prevention & Treatment

Effects of Vasodilation in Heart Failure With Preserved or Reduced Ejection Fraction: Implications of Distinct Pathophysiologies on Response to Therapy

S Schwartzenberg, MM Redfield... - Journal of the ..., 2012 - Am Coll Cardio Found Objectives: The purpose of this study was to compare hemodynamic responses to vasodilator therapy in patients with heart failure (HF) and preserved ejection fraction (HFp EF) versus HF and reduced ejection fraction (HFr EF). Background: There is no ... [CITATION] Anticipatory Grief Among Family Caregivers of Patients With Advanced Cancer, Congestive Heart Failure, and Chronic Obstructive Pulmonary Disease ( ...J Sautter, K Steinhauser... - Journal of Pain and Symptom ..., 2012 - Elsevier

Shmuel Schwartzenberg, MD, Margaret M. Redfield, MD, Aaron M. From, MD, Paul Sorajja, MD, Rick A. Nishimura, MD and Barry A. Borlaug, MD*

Manuscript received June 10, 2011; revised manuscript received August 22, 2011, accepted September 20, 2011.

Objectives: The purpose of this study was to compare hemodynamic responses to vasodilator therapy in patients with heart failure (HF) and preserved ejection fraction (H Fp EF) versus HF and reduced ejection fraction (H Fr EF).

Methods: We compared baseline hemodynamics and acute responses to vasodilation with intravenous sodium nitroprusside in patients with H Fr EF (n = 174) and H Fp EF (n = 83), determined invasively by cardiac catheterization.

Results: Baseline blood pressure, stroke volume, and cardiac output were greater in H Fp EF than H Fr EF, while pulmonary artery mean and pulmonary wedge pressures were similar. Left ventricular filling pressures were reduced to a similar extent in each group with nitroprusside, but the drop in systemic arterial pressure was 2.6-fold greater in H Fp EF (p < 0.0001), and improvements in stroke volume and cardiac output were each 60% lower in H Fp EF compared to H Fr EF (p < 0.0001). Despite similarly elevated filling pressures, H Fp EF patients were fourfold more likely than H Fr EF to experience a reduction in stroke volume with nitroprusside (p < 0.0001), suggesting greater vulnerability to preload reduction. Pulmonary artery systolic pressure dropped more in H Fp EF than in H Fr EF despite similar reduction in pulmonary mean pressure and resistance, suggesting higher right ventricular systolic elastance in H Fp EF.

Conclusions: As compared to patients with H Fr EF, patients with H Fp EF experience greater blood pressure reduction, less enhancement in cardiac output, and greater likelihood of stroke volume drop with vasodilators. These findings emphasize fundamental differences in the 2 HF phenotypes and suggest that more pathophysiologically targeted therapies are needed for H Fp EF.