Circulation, Vol 63, 269-278, Copyright © 1981 by American Heart Association
B Massie, T Ports, K Chatterjee, W Parmley, J Ostland, J O'Young and F Haughom
To assess the clinical efficacy of chronic vasodilator therapy for
refractory congestive heart failure, the long-term follow-up (mean 13
months, range 3-30 months) was evaluated in 56 patients treated with
hydralazine, usually in combination with nitrates. In the first 6 months,
73% improved subjectively and 59% improved by one or two New York Heart
Association classifications; early improvement was usually sustained.
Mortality was high, 22% at 6 months and 37% at 12 months, but was
significantly lower in patients who had a clinical response to vasodilators
(21% in responders vs 55% in nonresponders at 1 year). The only clinical
indicator that differentiated responders from nonresponders was the
presence or absence of symptomatic progression before initiation of
vasodilator therapy. Pulmonary artery pressure, pulmonary capillary wedge
(PCW) pressure and stroke work index (SWI) before and during vasodilator
therapy correlated with clinical response and survival. Fifteen of 20
patients with PCW < 20 mm Hg and SWI greater than or equal to 30 g-m/m2
improved and survived, compared with two of 19 with PCS greater than or
equal to 20 mm Hg and SWI < 30 g- m/m2. Patients who did not have acute
hemodynamic improvement generally did not improve clinically, but neither
the percentage change nor the absolute change in any hemodynamic variable
predicted outcome in the remaining patients. The findings of this study
indicate that vasodilators produce clinical improvement in many patients
with refractory heart failure and that hemodynamic measurements are helpful
in predicting the outcome of therapy.
ARTICLES
Long-term vasodilator therapy for heart failure: clinical response and its relationship to hemodynamic measurements
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