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Original Research: Pulmonary Vascular Disease |

Left Ventricular Ejection Time in Acute Heart Failure Complicating Precapillary Pulmonary HypertensionSystolic Ejection Time in Pulmonary Hypertension

Benjamin Sztrymf, MD; Sven Günther, MD; Elise Artaud-Macari, MD; Laurent Savale, MD, PhD; Xavier Jaïs, MD; Olivier Sitbon, MD, PhD; Gérald Simonneau, MD; Marc Humbert, MD, PhD; Denis Chemla, MD, PhD
Author and Funding Information

From the Réanimation Médicale (Dr Sztrymf), Hôpital Antoine Béclère, AP-HP, Clamart; EA 4533, Assistance Publique-Hôpitaux de Paris (Drs Sztrymf and Chemla), Clamart; Université Paris-Sud (Drs Sztrymf, Günther, Artaud-Macari, Savale, Jaïs, Sitbon, Simonneau, Humbert, and Chemla), Faculté de Médecine, Le Kremlin-Bicêtre; AP-HP, Service de Pneumologie (Drs Sztrymf, Günther, Artaud-Macari, Savale, Jaïs, Sitbon, Simonneau, and Humbert), Hôpital Bicêtre, Le Kremlin-Bicêtre; and INSERM U999 (Drs Sztrymf and Humbert), Le Kremlin-Bicêtre, France.

Correspondence to: Benjamin Sztrymf, MD, Réanimation Médicale, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140 Clamart, France; e-mail: benjamin.sztrymf@abc.aphp.fr


For editorial comment see page 1435

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(5):1512-1520. doi:10.1378/chest.12-2659
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Background:  Novel noninvasive tools may improve the management of patients with pulmonary hypertension (PH) experiencing heart failure. Major right ventricle overload leads to decreased stroke volume, which shortens left ventricular ejection time (LVET). Our arterial tonometry study tested the hypothesis that LVET carries prognostic value in patients with precapillary PH with heart failure.

Methods:  Clinical, biologic, and radial artery tonometry variables were prospectively obtained at admission and at day 3 to 5 in 53 consecutive patients with PH admitted to our ICU for clinical deterioration. LVET was measured from the reconstructed aortic pressure curve.

Results:  Overall ICU mortality (median stay, 5 days) was 17%. At admission, the LVET was shorter in patients with unfavorable outcome (median, 228 milliseconds [25th-75th percentiles, 212-278 milliseconds] vs 257 milliseconds [237-277 milliseconds], P = .032), whereas other tonometric indices were similar. The LVET at entry (237 milliseconds) had 73% sensitivity and 89% specificity for identifying death in the ICU. Other prognostic factors at admission were higher serum levels of brain natriuretic peptide (BNP) and creatinine and lower natremia. Dobutamine requirement, higher furosemide dose, and higher oxygen flow were associated with unfavorable outcome. At the second evaluation, higher serum levels of creatinine and BNP, higher furosemide dose and oxygen flow, and dobutamine or norepinephrine requirement were associated with poor outcome. The change in LVET between admission and follow-up measurement was not associated with outcome. The 90-day mortality was 28%.

Conclusions:  Shortened LVET at ICU admission was a prognostic factor in patients with precapillary PH with heart failure. Previously documented prognostic factors were also confirmed in this cohort.

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