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Pulmonary Artery Catheter Effectiveness in Congestive Heart Failure—Reply
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In Reply: Drs Won and Kuschner emphasize the utility of tailoring therapy to an estimate of right-sided filling pressures during management of acutely decompensated heart failure. They suggest that monitoring of CVP could have provided useful information to supplement clinical assessment. In the ESCAPE trial, however, the clinical assessment strategy included only symptoms and physical examination to estimate right-sided pressures; there was no invasive venous monitoring in patients who did not receive a PAC.
High correlation of right-sided pressure with pulmonary capillary wedge (PCW) pressure in chronic heart failure has been demonstrated by Drazner et al.1 Recent analysis of patients receiving PACs in the ESCAPE trial confirmed that estimated jugular venous pressure provided the most reliable clinical evidence for elevated PCW pressure in this population,2 although some estimates were incorrect, and lower accuracy has been described in general intensive care unit populations.3 Other physical signs in the ESCAPE trial had . . . [Full Text of this Article]
Lynne W. Stevenson, MD
lstevenson@partners.org
Cardiovascular Division
Brigham and Women's Hospital
Boston, Mass
Christopher M. O’Connor, MD
Division of Cardiology
Duke University Medical Center
Durham, NC
Robert M. Califf, MD
Division of Cardiology
Duke Clinical Research Institute
Durham, NC
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