How Dynamic are Hemodynamics?: Short-Term Changes in Hemodynamic Measures and Indices among Heart Failure Patients

Abstract

Purpose Pulmonary arterial catheters (PAC) are valuable tools for guiding heart failure management and evaluating patients for advanced therapies. Although several hemodynamically-derived indices have prognostic value in patients with advanced heart failure, the short-term variance that can be seen in these measurements has not been well described. This study aimed to determine short-term variations in hemodynamic measurements and associated indices among heart failure patients. Methods Patients undergoing clinically-indicated PAC placement at our institution from April 2018 with serial hemodynamic measurements were prospectively recruited. Hemodynamics and clinical variables were collected at the time 0 and again at 24 hours. Hemodynamic indices frequently used to assess the right ventricle, including pulmonary artery pulsatility index (PAPi), right atrial pressure (RAP) to pulmonary capillary wedge pressure (PCWP) ratio, and transpulmonary gradient were also calculated for both time points. Results Data was available for 57 patients with an average of age 58.3 years. Compared to baseline measurements, 24-hour data revealed a significant reduction in RAP (-1.6 mmHg; p= Conclusion Our single-center experience with short-term hemodynamic measurements revealed improvement in filling pressures over 24 hours. Notably, in patients with initially elevated RAP, PAPi significantly improved. Such findings demonstrate that PAPi's utility as a risk prediction index must be considered in the context of its variability based on loading conditions, rather than as a static value.