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Low pulse pressure as a poor-man's indicator of a low cardiac index in patients with severe cardiac dysfunction
Colin J Petrie1, Kevin Damman, Pardeep S Jhund
1aDepartment of Cardiology, Monklands Hospital, Monkscourt Avenue Airdrie, Glasgow, Scotland, UK bDepartment of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands cBritish Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Insights
A low pulse pressure (PP) is a marker for reduced cardiac index (CI) in patients with cardiovascular disease, especially when CI is below 3 L/min/m². This finding may offer a simple estimation of cardiac output in severe heart failure.
Area of Science:
- Cardiology
- Hemodynamics
- Critical Care Medicine
Background:
- Low pulse pressure (PP) can indicate poor cardiac output (CO), but lacks comprehensive invasive hemodynamic characterization.
- Understanding the relationship between PP and CO is crucial for assessing cardiac function in cardiovascular disease.
Purpose of the Study:
- To investigate the relationship between pulse pressure (PP) and cardiac index (CI) in patients with cardiovascular disease.
- To determine if PP can serve as a surrogate marker for low cardiac output.
Main Methods:
- Analysis of cardiac catheterization data from 1897 patients with cardiovascular disease.
- Investigated the correlation between PP and CI across different ranges of CI.
- Multivariable regression analysis to identify independent predictors of low CI.
Main Results:
- A strong correlation between PP and CI was observed in patients with CI < 2 L/min/m² (r=0.414, P<0.001).
- A weak correlation was found for CI between 2-3 L/min/m² (r=0.161, P<0.001).
- Low PP independently predicted low CI in patients with CI < 3 L/min/m², irrespective of confounders.
Conclusions:
- In patients with a cardiac index below 3 L/min/m², a low pulse pressure is a significant marker of reduced cardiac output.
- Pulse pressure may serve as a valuable, non-invasive "poor-man's" surrogate for cardiac output in severe heart failure.
Aims:
A low pulse pressure (PP) may reflect poor cardiac output (CO), but has not been well characterized by invasive haemodynamic studies.
Methods:
We investigated the relationship between PP and cardiac index (CI) in patients with cardiovascular disease including those with normal and impaired cardiac function. Cardiac catheterization data from 1897 patients was analysed.
Results:
Mean age was 59 years; 57% were men, mean (SD) PP was 65 (25) mmHg and mean (SD) CI was 2.9 (0.8) l/min/m. Correlation between CI and PP was absent if the CI was more than 3 l/min/m, with a weak correlation if CI was between 2 and 3 l/min/m (r = 0.161; P < 0.001). For those with a CI of less than 2 l/min/m, the correlation was much stronger (r = 0.414; P < 0.001). In a multivariable regression analysis, a low PP predicted a low CI, at cardiac indices of less than 3 l/min/m. This was independent of potential confounders, including age, sex, presence of hypertension, presence of heart failure, presence of aortic stenosis, diabetes, renal function, heart rate, systemic vascular resistance, left ventricular end diastolic pressure and mean arterial pressure.
Conclusion:
In patients with a CI of less than 3 l/min/m, a low PP is a marker of a low CI. In patients with severe heart failure and a low CO, PP pressure might be useful as a 'poor-man's' surrogate of CO.
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