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To the Editor: In the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial, Dr Stevenson and colleagues¹ showed that the addition of the pulmonary artery catheter (PAC) to "clinical assessment alone" in the treatment of decompensated heart failure did not affect overall mortality and hospitalization. This finding of no effect could have been explained in part by use of continuous central venous pressure (CVP) monitoring via indwelling central venous lines other than PACs among participants randomized to receive therapy guided by clinical assessment alone. In the absence of pulmonary hypertension or profound right ventricular dysfunction, CVP provides a reasonable estimation of left ventricular filling characteristics.^2-3 Serial measurements of CVP may provide useful information about response to treatment of volume overload.⁴

It would be helpful for the authors to describe the use of central lines and CVP monitoring among participants in each study group, including use . . . [Full Text of this Article]

Christine Won, MD
Division of Pulmonary and Critical Care Medicine
Stanford University Medical Center
Stanford, Calif

Ware G. Kuschner, MD
ware.kuschnermd@med.va.gov
Medical Service, Pulmonary Section
US Department of Veterans Affairs
Palo Alto Health Care System
Palo Alto, Calif

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