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

Background Aggressive management to reduce pulmonary artery systolic pressure (PASP) and pulmonary capillary wedge pressure (PCWP) reduces hospitalization rates and is crucial for patients awaiting transplantation but may require periodic invasive monitoring with right heart catheterization. Methods The purpose of this study was to define the relation of transpulmonary passage of Albunex (Mallinckrodt Medical, St Louis, Mo) to intracardiac hemodynamic and clinical outcome in patients with chronic congestive heart failure (CHF). Patients (n=38) with chronic CHF underwent graded dobutamine infusion (baseline, 5, 10, 20 μg/kg per minute; 5-minute stages) with 5.0 mL Albunex injected intravenously at each stage. The dobutamine dose at which Albunex appeared in the left ventricle was determined. All patients had right heart catheterization to determine PASP and PCWP. Results Transpulmonary passage of Albunex at baseline or at 5 μg/kg per minute dobutamine infusion predicted PCWP <20 mm Hg with a positive predictive value of 100% and a negative predictive value of 79%. Initial appearance of Albunex in the left ventricle at a dobutamine dose of 20 μg/kg per minute or failure to appear at any dose predicted a PCWP> 20 mm Hg with a positive predictive value of 100% and a negative predictive value of 94%. No patient with Albunex passage at baseline sustained a major adverse event. Major adverse events occurred in 11 of 21 patients in whom Albunex either failed to cross or crossed the pulmonary bed at a dose of 20 μg/kg per minute 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 for an adverse outcome.