Dynamic changes in echocardiographic parameters in acute decompensated heart failure: REALITY-ECHO.

Acute heart failure B-type natriuretic peptide Echocardiography Emergency care Hemodynamics

Journal

Journal of cardiology
ISSN: 1876-4738
Titre abrégé: J Cardiol
Pays: Netherlands
ID NLM: 8804703

Informations de publication

Date de publication:
25 Oct 2023
Historique:
received: 26 05 2023
revised: 11 09 2023
accepted: 06 10 2023
pubmed: 27 10 2023
medline: 27 10 2023
entrez: 26 10 2023
Statut: aheadofprint

Résumé

Appropriate evaluation of hemodynamic status is vital in the management of acute heart failure (AHF). We aimed to investigate the changes in echocardiographic parameters during very acute phases of AHF and their association with clinical outcomes. Patients who were admitted to four Japanese hospitals with AHF were prospectively enrolled. Comprehensive echocardiography and B-type natriuretic peptide (BNP) were assessed both on admission and the second day. A total of 271 patients (80 ± 12 years old, 52 % male) was included. Overall, transmitral E velocity, E/A, tricuspid regurgitation pressure gradient (TRPG), and inferior vena cava diameter significantly decreased, and stroke volume and left ventricular ejection fraction showed a significant increase by the second day, whereas E/e' did not change. On the second day, BNP increased in 50 patients (18 %). Despite similar baseline characteristics, patients with increased BNP showed a significantly smaller improvement in transmitral flow parameters (E and A velocity, E/A, and flow patterns) and a smaller decrease in TRPG compared with patients with decreased BNP. Other echocardiographic parameter changes were not different between the groups. A combination of improvement in transmitral flow and TRPG was significantly associated with 90-day and 1-year composite events of all-cause death and heart failure hospitalization after adjustment by the Get With the Guidelines-Heart Failure risk score. Echocardiographic parameters show a dynamic change in the very acute phase of AHF. Several parameters, such as the transmitral flow and TRPG might be useful in monitoring favorable hemodynamic change.

Sections du résumé

BACKGROUND BACKGROUND
Appropriate evaluation of hemodynamic status is vital in the management of acute heart failure (AHF). We aimed to investigate the changes in echocardiographic parameters during very acute phases of AHF and their association with clinical outcomes.
METHODS METHODS
Patients who were admitted to four Japanese hospitals with AHF were prospectively enrolled. Comprehensive echocardiography and B-type natriuretic peptide (BNP) were assessed both on admission and the second day.
RESULTS RESULTS
A total of 271 patients (80 ± 12 years old, 52 % male) was included. Overall, transmitral E velocity, E/A, tricuspid regurgitation pressure gradient (TRPG), and inferior vena cava diameter significantly decreased, and stroke volume and left ventricular ejection fraction showed a significant increase by the second day, whereas E/e' did not change. On the second day, BNP increased in 50 patients (18 %). Despite similar baseline characteristics, patients with increased BNP showed a significantly smaller improvement in transmitral flow parameters (E and A velocity, E/A, and flow patterns) and a smaller decrease in TRPG compared with patients with decreased BNP. Other echocardiographic parameter changes were not different between the groups. A combination of improvement in transmitral flow and TRPG was significantly associated with 90-day and 1-year composite events of all-cause death and heart failure hospitalization after adjustment by the Get With the Guidelines-Heart Failure risk score.
CONCLUSIONS CONCLUSIONS
Echocardiographic parameters show a dynamic change in the very acute phase of AHF. Several parameters, such as the transmitral flow and TRPG might be useful in monitoring favorable hemodynamic change.

Identifiants

DOI: 10.1016/j.jjcc.2023.10.007 PMID: 37884192
pubmed: 37884192
pii: S0914-5087(23)00268-X
doi: 10.1016/j.jjcc.2023.10.007
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 Elsevier Ltd. All rights reserved.

Auteurs

Saori Uchiyama (S)

Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.

Misako Toki (M)

Department of Clinical Laboratory, The Sakakibara Heart Institute of Okayama, Okayama, Japan.

Takeshi Kitai (T)

Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan; National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine Osaka, Japan.

Kenji Yoshioka (K)

Department of Cardiology, Kameda Medical Center, Chiba, Japan; Department of Cardiology, Chiba, Japan.

Akihiro Hayashida (A)

Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan.

Kiyoshi Yoshida (K)

Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan.

Yuya Matsue (Y)

Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Cardiology, Kameda Medical Center, Chiba, Japan.

Masayoshi Yamamoto (M)

Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.

Tohru Minamino (T)

Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.

Nobuyuki Kagiyama (N)

Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan; Department of Digital Health and Telemedicine R&D, Juntendo University, Tokyo, Japan. Electronic address: kgnb_27_hot@yahoo.co.jp.

Classifications MeSH