Excessive wave reflections on admission predict post‐discharge events in patients hospitalized due to acute heart failure

Abstract

The role of wave reflections in the pathogenesis of acute heart failure syndrome (AHFS) remains unclear. The present study investigated the long-term prognostic values of the carotid augmentation index (cAI), carotid augmented pressure (cAP), amplitude of the reflected pressure wave from a decomposed carotid pressure wave (Pb), and carotid pulse pressure (PP) on admission in patients hospitalized due to AHFS. A total of 120 patients (72 ± 14 years, 83.3% men) hospitalized due to AHFS (55.8% with systolic heart failure) were enrolled. Measures of cAI, cAP, Pb, carotid PP, and carotid-femoral pulse wave velocity (cf-PWV) by tonometry and thoracic fluid content (TFC) by impedance cardiography were obtained within 24 h of admission. N-terminal pro brain natriuretic peptide (NT-proBNP) levels were determined before discharge. Patients were followed up for a median of 601 days, accruing 66 adverse events including re-hospitalization for heart failure, non-fatal myocardial infarction, non-fatal stroke, and death. In univariate Cox analysis, all measures significantly predicted post-discharge events (all P < 0.05). In multivariate analysis, cAP [hazard ratio per SD and 95% confidence interval: 1.32 (1.051-1.67), P = 0.017], Pb [1.44 (1.13-1.84), P = 0.004] and carotid PP [1.35 (1.05-1.73), P = 0.019], but not cAI, TFC, or cf-PWV, significantly independently predicted events with adjustments for age, estimated glomerular filtration rate, haemoglobin, and NT-proBNP. On-admission measures of wave reflection magnitude, including cAP, Pb, and carotid PP, may be useful for predicting long-term outcomes in AHFS patients. The results support a major role for wave reflection in the pathogenesis of AHFS.