Clinical presentations and hemodynamic parameters in patients hospitalized due to acute heart failure stratified by the left-ventricular ejection fraction

Abstract

Background: Currently, one of the most common causes of hospitalization, especially in the elderly, is heart failure (HF) exacerbation. In nearly 95% of patients, this is caused by fluid overload. There have been studies comparing the rates of comorbidities and biochemical disturbances in HF patients; however, their hemodynamic parameters have not yet been assessed. Thus, the aim of this study was to compare the clinical presentations and hemodynamic parameters assessed via impedance cardiography (ICG) in patients hospitalized due to acute HF, stratified by the left-ventricular ejection fraction (LVEF). Methods: This study enrolled 102 patients, aged > 18 years, hospitalized due to decompensated HF. Ninety-seven patients (74 men, 23 women) underwent echocardiographic examination. Biochemical and hemodynamic parameters were assessed on the day of admission and, subsequently, every other day during hospitalization. Based on echocardiographic findings and the ESC guidelines the study group was divided into the following subgroups: HFrEF (EF 50%), and HFmrEF (EF 40–49%). Results: The HFrEF group, which constituted 60.8% of patients (n = 58), was predominantly male (P = 0.0005); and most had elevated N-terminal pro-brain natriuretic peptide levels (P = 0.0008). The HFpEF and HFmrEF subgroups, jointly (n = 38), were characterized by higher systolic blood pressure (P = 0.0001), and lower hemoglobin levels (P = 0.003). The hemodynamic assessment showed that HFrEF patients had higher total fluid content (P = 0.005) and lower systolic time ratio (P = 0.0002). Conclusions: Despite similar clinical presentation, patients with HF exhibited different values of hemodynamic and biochemical parameters depending on their LVEF; this indicates non-homogeneity of pathomechanisms and causes of HF decompensation.