122 - Prediction of Heart Failure Readmission Using Echocardiographic Variables in Patients with Heart Failure with Preserved Ejection Fraction in an Urban Inner City Teaching Hospital

Abstract

Objective: The purpose of this study was to determine the relationship between echocardiographic variables and hospital readmission rates in patients with Heart Failure with preserved EF (HFpEF) admitted for acute decompensated heart failure (HF). Background: Acute HF exacerbation in patients with HFpEF is caused by congestion which may be not clinically evident. Congestion is due to elevated LV filling pressure which is often reflected by high levels of natriuretic peptides. Using the echocardiogram to determine specific parameters such as LVEDP, E/e' ratio, left atrial volume index can help to identify patients with elevated filling pressures that are congested but may not be reflected clinically and may be increased risk for HF readmission. Methods: One hundred sixteen patients with HFpEF who were admitted for acute HF exacerbation with an echocardiogram done during initial presentation were included. Patients were divided based on readmission in 60 days. Continuous variables were analyzed using Wilcoxon rank sum test and categorical variables(atrial fibrillation, coronary artery disease, diabetes mellitus, hypertension, hyperlipidemia, gender, race) were analyzed using Fisher's exact test. The best subset selection method was performed to assess the best predictive model of readmission. Results: There were no significant relationship between readmission and any of the categorical variables. A significant relationship was noted between readmission and both NT pro-BNP and left atrial (LA) Volume index (ml/m2). The best fit model predicting readmission was applied to E/e' ratio and LA volume index (ml/m2). For every unit increase in E/e' ratio, the odds of readmission decreased. For every unit increase in LA Volume index, the odds of readmission increased. Conclusion: Our results reveal that LA volume index predicted HF readmission in HFpEF patients, while E/e' ratio did not. This could be due to the dynamic nature of E/e' being volume related and unclear timing of the echocardiogram in relation to diuresis. Increased LA volume index correlating with readmission appropriately reflects the pathophysiology of HFpEF and LA remodeling in these patients. The analysis showed significant correlation with HF readmission rates in patients with higher NT proBNP levels. LA volume index can be considered as an additional prognostic marker for HF readmission. Further studies are warranted to evaluate echocardiographic variables at the time of admission for acute decompensated HF in HFpEF patients.