Hemodynamic responses to rapid saline loading: The impact of age, sex, and heart failure

Naoki Fujimoto, Barry A. Borlaug, Gregory D. Lewis, Jeffrey L. Hastings, Keri M. Shafer, Paul S. Bhella, Graeme Carrick-Ranson, Benjamin D. Levine

Research output: Contribution to journalArticle

102 Scopus citations

Abstract

Background-Hemodynamic assessment after volume challenge has been proposed as a way to identify heart failure with preserved ejection fraction. However, the normal hemodynamic response to a volume challenge and how age and sex affect this relationship remain unknown. Methods and Results-Sixty healthy subjects underwent right heart catheterization to measure age-and sex-related normative responses of pulmonary capillary wedge pressure and mean pulmonary arterial pressure to volume loading with rapid saline infusion (100-200 mL/min). Hemodynamic responses to saline infusion in heart failure with preserved ejection fraction (n=11) were then compared with those of healthy young (<50 years of age) and older (≥50 years of age) subjects. In healthy subjects, pulmonary capillary wedge pressure increased from 10±2 to 16±3 mm Hg after ~1 L and to 20±3 mm Hg after ~2 L of saline infusion. Older women displayed a steeper increase in pulmonary capillary wedge pressure relative to volume infused (16±4 mm Hg·L·m) than the other 3 groups (P≤0.019). Saline infusion resulted in a greater increase in mean pulmonary arterial pressure relative to cardiac output in women compared with men regardless of age. Subjects with heart failure with preserved ejection fraction exhibited a steeper increase in pulmonary capillary wedge pressure relative to infused volume (25±12 mm Hg·L·m) than healthy young and older subjects (P≤0.005). Conclusions-Filling pressures rise significantly with volume loading, even in healthy volunteers. Older women and patients with heart failure with preserved ejection fraction exhibit the largest increases in pulmonary capillary wedge pressure and mean pulmonary arterial pressure.

Original languageEnglish (US)
Pages (from-to)55-62
Number of pages8
JournalCirculation
Volume127
Issue number1
DOIs
Publication statusPublished - Jan 1 2013

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Keywords

  • age and sex difference
  • filling pressure
  • heart failure
  • stroke volume
  • volume loading

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

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