Hemodynamic forces analysis using transthoracic echocardiogram in acute heart failure

Abstract

Abstract Introduction Heart failure (HF) represents a major health problem, being one of the leading causes of hospitalization. At present, echocardiography plays a key role in HF diagnosis and many innovations have been made. Particularly, in the last decades attention was directed towards fluid dynamic study, as it seems to better predict ventricular dysfunction. Therefore, the concept of hemodynamic forces (HDF) was introduced. Purpose The aim of our study was to evaluate HDF in patients with acute HF in the setting of the Emergency Room and at the time of recovery, furthermore, comparing them with healthy volunteers. Patients were also contacted 30 days after discharge in order to evaluate whether there had been new hospital admissions. Methods We enrolled 132 patients, of whom only 14 were effectively recruited given the need for the presence of sinus rhythm and the absence of severe valvulopathies. These patients were compared with 8 healthy volunteers. All individuals underwent trans-thoracic echocardiography, in order to assess cardiac morphology and function. HDF analysis was performed using QStrain software. Results The graphical presentation of HDF analysis differed in a statistically significant manner between patients with acute HF and healthy volunteers, with the first group showing a lower systolic peak (7.66% [6.32;14.3] vs 21.6 % [18.4;26.7]; p 0.003) and a shorter diastolic time (372 msec [342;472] vs 631 msec [468;679]; p = 0.012). Moreover, in patients with HF we identified a statistically significant reduction of the Inward Displacement (ID), a recently introduced parameter of systolic function, (12667 [10404;22647] vs 27289 [25131;29001]; p 0.003) and an increased systolic ratio, consisting of the ratio between transverse and apical-basal HDF (23.6±10.9 in HF patients vs 17.5±5.60 in healthy subjects; p = 0.102). Comparing patients with HF in the acute phase and at the time of recovery, we couldn’t obtain statistically significant results due to the small sample size. However, considering case by case, we pointed out a difference in ID and in systolic ratio which seemed to better identify effective hemodynamic stability compared with Ejection Fraction (EF) and Global Longitudinal Strain (GLS). Conclusion Our study appears to be the first one to evaluate HDF in the setting of acute HF. Our results suggest how HDF analysis could be a useful tool improving HF management, particularly leading to a better identification of effective hemodynamic compensation. However, we also emphasized the limitations of this tool, which currently restrict its use to the outpatient setting, particularly in the field of research.