Central venous pressure at emergency room presentation predicts cardiac rehospitalization in patients with decompensated heart failure

Abstract

Aims: To investigate the relationship between central venous pressure (CVP) at presentation to the emergency room (ER) and the risk of cardiac rehospitalization and mortality in patients with decompensated heart failure (DHF).

Methods and results: Central venous pressure was determined non-invasively using high-resolution compression sonography at presentation in 100 patients with DHF. Cardiac hospitalizations and cardiac and all-cause mortality were assessed as a function of continuous CVP levels and predefined CVP categories (low <6 cm H(2)O, intermediate 6-23 cm H(2)O, and high >23 cm H(2)O). Endpoints were adjudicated blinded to CVP. At presentation, mean age was 78 +/- 11 years, 60% of patients were male, mean B-type natriuretic peptide level was 1904 +/- 1592 pg/mL, and mean CVP was 13.7 +/- 7.0 cm H(2)O (range 0-33). During follow-up (median 12 months), 25 cardiac rehospitalizations, 26 cardiac deaths, and 7 non-cardiac deaths occurred. Univariate and stepwise multivariate Cox regression analysis revealed an independent relationship between CVP and cardiac rehospitalization (HR 1.09, 95% CI 1.01-1.18, P = 0.034). Kaplan-Meier analyses confirmed a stepwise increase in cardiac rehospitalization for low-to-high CVP (log-rank test P = 0.015). No association between CVP and (cardiac) mortality was detectable.

Conclusion: Central venous pressure at ER presentation in patients with DHF is an independent predictor of cardiac rehospitalization but not of cardiac and all-cause mortality.