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Title: | Improved cardiac and venous pressures during hospital stay in patients with acute heart failure: an echocardiography and biomarkers study | Authors: | Akiyama, Eiichi Cinotti, Raphael Cerlinskaite, Kamile Van Aelst, Lucas N. L. Arrigo, Mattia Placido, Rui Chouihed, Tahar Girerd, Nicolas Zannad, Faiez Rossignol, Patrick Badoz, Marc Launay, Jean-Marie Gayat, Etienne Cohen-Solal, Alain Lam, Carolyn S. P. Testani, Jeffrey MULLENS, Wilfried Cotter, Gad Seronde, Marie-France Mebazaa, Alexandre |
Issue Date: | 2020 | Publisher: | WILEY PERIODICALS, INC | Source: | ESC HEART FAILURE, 7 (3) , p. 996 -1006 | Abstract: | Aims Changes in echocardiographic parameters and biomarkers of cardiac and venous pressures or estimated plasma volume during hospitalization associated with decongestive treatments in acute heart failure (AHF) patients with either preserved left ventricular ejection fraction (LVEF) (HFPEF) or reduced LVEF (HFREF) are poorly assessed. Methods and results From the metabolic road to diastolic heart failure: diastolic heart failure (MEDIA-DHF) study, 111 patients were included in this substudy: 77 AHF (43 HFPEF and 34 HFREF) and 34 non-cardiac dyspnea patients. Echocardiographic measurements and blood samples were obtained within 4 h of presentation at the emergency department and before hospital discharge. In AHF patients, echocardiographic indices of cardiac and venous pressures, including inferior vena cava diameter [from 22 (16-24) mm to 13 (11-18) mm, P = 0.009], its respiratory variability [from 32 (8-44) % to 43 (29-70) %, P = 0.04], medial E/e' [from 21.1 (15.8-29.6) to 16.6 (11.7-24.3), P = 0.004], and E wave deceleration time [from 129 (105-156) ms to 166 (128-203) ms, P = 0.003], improved during hospitalization, similarly in HFPEF and HFREF patients. By contrast, no changes were seen in non-cardiac dyspnea patients. In AHF patients, all plasma biomarkers of cardiac and venous pressures, namely B-type natriuretic peptide [from 935 (514-2037) pg/mL to 308 (183-609) pg/mL, P < 0.001], mid-regional pro-atrial natriuretic peptide [from 449 (274-653) pmol/L to 366 (242-549) pmol/L, P < 0.001], and soluble CD-146 levels [from 528 (406-654) ng/mL to 450 (374-529) ng/mL, P = 0.003], significantly decreased during hospitalization, similarly in HFPEF and HFREF patients. Echocardiographic parameters of cardiac chamber dimensions [left ventricular end-diastolic volume: from 120 (76-140) mL to 118 (95-176) mL, P = 0.23] and cardiac index [from 2.1 (1.6-2.6) mL/min/m(2) to 1.9 (1.4-2.4) mL/min/m(2), P = 0.55] were unchanged in AHF patients, except tricuspid annular plane systolic excursion (TAPSE) that improved during hospitalization [from 16 (15-19) mm to 19 (17-21) mm, P = 0.04]. Estimated plasma volume increased in both AHF [from 4.8 (4.2-5.6) to 5.1 (4.4-5.8), P = 0.03] and non-cardiac dyspnea patients (P = 0.01). Serum creatinine [from 1.18 (0.90-1.53) to 1.19 (0.86-1.70) mg/dL, P = 0.89] and creatinine-based estimated glomerular filtration rate [from 59 (40-75) mL/min/1.73m(2) to 56 (38-73) mL/min/1.73m(2), P = 0.09] were similar, while plasma cystatin C [from 1.50 (1.20-2.27) mg/L to 1.78 (1.33-2.59) mg/L, P < 0.001] and neutrophil gelatinase associated lipocalin (NGAL) [from 127 (95-260) ng/mL to 167 (104-263) ng/mL, P = 0.004] increased during hospitalization in AHF. Conclusions Echocardiographic parameters and plasma biomarkers of cardiac and venous pressures improved during AHF hospitalization in both acute HFPEF and HFREF patients, while cardiac chamber dimensions, cardiac output, and estimated plasma volume showed minimal changes. | Notes: | Mebazaa, A (corresponding author), Hop Univ St Louis Lariboisiere, Dept Anesthesia & Crit Care, 2 Rue Ambroise Pare, F-75010 Paris, France. alexandre.mebazaa@aphp.fr |
Other: | Mebazaa, A (corresponding author), Hop Univ St Louis Lariboisiere, Dept Anesthesia & Crit Care, 2 Rue Ambroise Pare, F-75010 Paris, France. alexandre.mebazaa@aphp.fr | Keywords: | Acute heart failure;Congestion;Biomarker;Echocardiography;Heart failure with preserved ejection fraction;Heart failure with reduced ejection fraction | Document URI: | http://hdl.handle.net/1942/31820 | ISSN: | 2055-5822 | e-ISSN: | 2055-5822 | DOI: | 10.1002/ehf2.12645 | ISI #: | WOS:000536512400027 | Rights: | © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2021 |
Appears in Collections: | Research publications |
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