The Many Fronts of Heart Failure Monitoring – An Observational Study into Heart Failure Patients using Right Heart Catheterisation and Pulse Wave Analysis

Billy Poulden, Dr Audrey Adji, Professor Christopher Hayward

Introduction

Heart failure (HF) is a condition that occurs when a person’s heart is unable to pump enough blood to adequately supply the body. The rate of HF in the adult population of the developed world is 1-2%. There are many ways to monitor the severity of heart failure, including right heart catheterisation (RHC) and arterial pulse wave analysis (PWA). RHC directly measures pressures relating to the right heart, which are important predictors of severity of heart failure.  PWA evaluates the contour of the pulse and estimates the central pressure which the heart has to pump against, and the degree of arterial stiffness. In this observational study, our aim is to compare the hemodynamic parameters of 6 patients who underwent RHC and PWA, and associate these parameters measured from RHC and PWA to their clinical picture.

Methods/description

This study was conducted as a case control observational study. There were 6 subjects in the study, 3 males and 3 females. All patients underwent RHC to determine their right heart and pulmonary pressures. Patients underwent PWA using the Sphygmocor system to derive their aortic pulse waves from brachial artery cuff and thereby determine central systolic pressure (CSP), central pulse pressure (CPP) and aortic augmentation index (AAI). The patients were graded on their symptomatic severity of heart failure using the NYHA scoring system.

Of the 6 subjects, all had a NYHA grading of at least 2, the highest being 3. All subjects were found to be in some degree of pulmonary hypertension by the right heart catheter studies, with PCWP ranging from 16-28mmHg. The AAIs ranged from 16.46-45.22. The PCWP appeared to correlate with the AAI, excluding one outlier.

Discussion

There are many ways to predict severity and prognosis in heart failure. In this study, we found that all subjects were in clinical heart failure by their NYHA score, and this was consistent with their RHC measurements. We also found a potential correlation between AAIs and NYHA score. By looking at a wide range of parameters from these various prognostic procedures, we can better understand how they relate to each other.

Conclusion

There is an extensive bed of research on RHC parameters and a growing area of research on PWA. By comparing the parameters and how they relate to symptoms, we can better understand HF monitoring.