Transpulmonary passage of Albunex as a marker of intracardiac hemodynamicsand outcome in chronic congestive heart failure

Background Aggressive management to reduce pulmonary artery systolic pressu re (PASP) and pulmonary capillary wedge pressure (PCWP) reduces hospitaliza tion rates and is crucial for patients awaiting transplantation but may req uire periodic invasive monitoring with right heart catheterization. Methods The purpose of this study was to define the relation of transpulmon ary passage of Albunex (Mallinckrodt Medical, St Louis, Mo) to intracardiac hemodynamics and clinical outcome in patients with chronic congestive hear t failure (CHF). Patients (n = 38) with chronic CHF underwent graded dobuta mine infusion (baseline, 5, 10, 20 mu g/kg per minute; 5-minute stages) wit h 5.0 mi Albunex injected intravenously at each stage. The dobutamine dose at which Albunex appeared in the left ventricle was determined. All patient s had right heart catheterization to determine PASP and PCWP. Results Transpulmonary passage of Albunex at baseline or at 5 mu g/kg per m inute dobutamine infusion predicted PCWP <20 mm Hg with a positive predicti ve value of 100% and a negative predictive value of 79%. Initial appearance of Albunex in the left ventricle at a dobutamine dose of 20 mu g/kg per mi nute or failure to appear at any dose predicted a PCWP >20 mm Hg with a pos itive predictive value of 100% and a negative predictive value of 94%. No p atient with Albunex passage at baseline sustained a major adverse event. Ma jor adverse events occurred in 11 of 21 patients in whom Albunex either fai led to cross or crossed the pulmonary bed at a dose of 20 mu g/kg per minut e of dobutamine. Conclusion In patients with chronic CHF, transpulmonary passage of Albunex during dobutamine infusion can be used to predict both elevated and normal intracardiac pressures and to identify a subset of patients at high risk fo r an adverse outcome.