Are de novo acute heart failure and acutely worsened chronic heart failure two subgroups of the same syndrome?

Abstract

Acute heart failure (AHF) is one of the most common diseases in emergency medicine, associated with poor prognosis and high in-hospital and long-term mortality. To investigate clinical presentation of patients with de novo AHF and acute worsening of chronic heart failure (CHF) and to identify differences in blood levels of biomarkers and echocardiography findings. This prospective study comprised 64 consecutive patients being grouped according to the onset of the disease into patients with the de novo AHF (45.3%), and patients with acute worsening of CHF (54.7%). Acute congestion (60%) was the most common manifestation of de novo AHF, whereas pulmonary oedema (43.1%) was the most common manifestation of acutely decompensated CHF. Patients with acutely decompensated CHF had significantly higher blood values of creatinine (147.10 vs 113.16 micromol/l; p < 0.05), urea (12.63 vs. 7.82 mmol/l; p < 0.05), BNP (1440.11 vs. 712.24 pg/ml; p < 001) and NTproBNP (9097.00 vs. 2827.70 pg/ml; p < 0.01) on admission, and lower values of M-mode left ventricular ejection fraction (LVEF) during hospitalization (49.44% vs. 42.94%; p < 0.05). The follow-up after one year revealed still significantly higher BNP (365.49 vs. 164.02 pg/ml; p < 0.05) and lower average values of both LVEF in patients with acutely worsened CHF (46.62% vs. 54.41% and 39.52% vs. 47.88%; p < 0.05). Considering differences in clinical severity on admission, echocardiography and natriuretic peptide values during hospitalization and after one year follow-up, de novo AHF and acutely worsened CHF are two different subgroups of the same syndrome.