Impact of left ventricular systolic diameter on the in-hospital improvement of systolic function in acute decompensated heart failure with high blood pressure presentation

Abstract

Purpose: In-hospital improvement of left ventricular (LV) systolic function is frequently observed in acute decompensated heart failure (ADHF) patients presented with high systolic blood pressure (SBP) on admission. However, determinants of improved LV systolic function in patients with ADHF remain unclear. Methods: We examined 214 consecutive patients admitted by ADHF with SBP > 140 mmHg, impaired LV systolic function, defined as LV ejection fraction (EF) < 50% or fractional shortning < 26%, but no acute coronary syndrome. Patients were divided into 2 groups according to the presence or absence of improved LV systolic function, defined as normalized predischarge LV systolic function. Results: Improved LV systolic function was observed in 54 patients and length of hospital stay was comparable between two groups. Patients with improved LV systolic function had lower BNP level, smaller LV systolic and diastolic diameters at admission, higher baseline and % increase of LV systolic function than those without. ROC curves showed that smaller LV systolic diameter (LVSD) at admission was superior to other variables for predicting improved LV systolic function (AUC: 0.80) (Figure). Multivariate logistic regression analysis showed that smaller LVSD (<46mm) was the strongest independent determinant for improvement of LV systolic function (OR: 6.51, 95% CI: 1.60-26.34, p=0.0086) among variables including lower BNP level (OR: 2.09, 95% CI: 1.01-4.30), no history of coronary artery disease (OR: 2.37, 95% CI: 1.12-5.01), and LV diastolic diameter at admission (p = 0.98). ![Figure][1] Figure 1 Conclusions: Smaller LVSD at admission was the strongest determinant for in-hospital improvement of LV systolic function in patients with ADHF with high blood pressure and impaired LV systolic function. [1]: pending:yes