Right Heart Hemodynamics
Visualizing Hemodynamics During Biventricular Support
Dr. Daniel Burkhoff presents a graphic representation of a HARVI simulated case of biventricular support in a patient with biventricular failure. Using the metrics of central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP), he demonstrates the hemodynamic impact of therapies over the course of treatment for this patient.
"One construct that we have found to be helpful in summarizing how to follow and how to think about these patients with complex hemodynamic problems, is using this diagram, which tracks CVP and wedge pressure simultaneously at different points in time.” Dr. Burkhoff tells interviewer Dr. Cathy Jeon.
Using a case he described in a longer version of this interview, Dr. Burkhoff explains the baseline characteristics of the patient and how CVP and PCWP changed over the course of treatment. The patient started with very high CVP and marginal wedge pressure. After initiating left-sided support with Impella CP®, the wedge pressure dropped dramatically, but the CVP increased slightly. “So, you see, we’re going in the wrong direction,” he explains.
“Then we put in the RP full throttle. We had a marked reduction in CVP, which is what we were shooting for, but the wedge pressure went way, way up.” Dr. Burkhoff then explains how the patient wound up in the euvolemic target range after reducing the speed of the Impella RP® and adding diuresis.
Dr. Burkhoff explains how this diagrammatic construct is very useful for illustrating “how RVAD/LVAD interactions occur, and also putting on top of that the impact of medical therapies.” He also emphasizes that it is clinically useful to know that you want to get to the bottom left quadrant of the diagram, the euvolemic state. There, CVP and PCWP are in the target range, which he loosely defines for this case in the longer interview, as wedge pressures in the high teens or low 20s and CVP in the range of 10-12 mmHg.
Dr. Burkhoff is director of the Cardiovascular Research Foundation also the developer of the HARVI hemodynamics app, which helps clinicians better understand what’s going on in a patient’s heart and vasculature as well as what happens from a hemodynamic and physiologic standpoint with different therapies and interventions.
- Dr. Dan Burkhoff: Key to Recognizing Need for Biventricular Support
- Drs. Dan Burkhoff and Martin Leon: Understanding the Hemodynamics of Protected PCI with Impella
- Importance of Right Heart Catheterization
To learn more about the Impella® platform of heart pumps, including important risk and safety information associated with the use of the devices, please visit: www.protectedpci.com/indications-use-safety-information/