Improving the EHMRG Prognostic Evaluation of Acute Heart Failure with TAPSE/PASp: A Sequential Approach.

Lorenzo Falsetti,Vincenzo Zaccone,Agnese Fioranelli,Luca Giuliani,Emanuele Guerrieri,Adolfo Pansoni,Ilaria Diblasi,Consuelo Ferrini,Nicola Tarquinio,Caterina Scalpelli,Gianluca Moroncini,Marinella Luccarini,Maurizio Burattini,Giovanna Viticchi,Marianna Martino,Mattia Scarponi

doi:10.3390/diagnostics12020478

Abstract

The Emergency Heart Failure Mortality Risk Grade (EHMRG) can predict short-term mortality in patients admitted for acute heart failure (AHF) in the emergency department (ED). This paper aimed to evaluate if TAPSE/PASp, an echocardiographic marker of ventricular desynchronization, can improve in-hospital death prediction in patients at moderate-to-high risk, according to EHMRG score classification. From 1 January 2018 to 30 December 2019, we retrospectively enrolled all the consecutive subjects admitted to our Internal Medicine Department for AHF from the ED. We performed bedside echocardiography within the first 24 h of admission. We evaluated EHMRG and NYHA in the ED, days of admission in Internal Medicine, and in-hospital mortality. We assessed cutoffs with ROC curve analysis and survival with Kaplan–Meier and Cox regression. We obtained a cohort of 439 subjects; 10.3% underwent in-hospital death. Patients with normal TAPSE/PASp in EHMRG Classes 4, 5a, and 5b had higher survival rates (100%, 100%, and 94.3%, respectively), while subjects with pathologic TAPSE/PASp had lower survival rates (81.8%, 78.3%, and 43.4%, respectively) (p < 0.0001, log-rank test). TAPSE/PASp, an echocardiographic marker of ventricular desynchronization, can further stratify the risk of in-hospital death evaluated by EHMRG.

Highlights

Heart failure (HF) is a global public health problem characterized by high mortality and increased hospitalization rates [1]
In a population of elderly subjects admitted for Acute heart failure (AHF), whether a sequential approach based on an initial Emergency Heart Failure Mortality Risk Grade (EHMRG) evaluation, and a subsequent risk stratification based on an echocardiographic marker, namely TAPSE/PASp, was able to identify patients at lower risk of short-term mortality among subjects classified as in moderate-to-high risk according to EHMRG score classification
In EHMRG class 4, a normal TAPSE/PASp was associated with 100% survival, while a pathological TAPSE/PASp was associated with 81.8% survival (Figure 5a, p = 0.010 at log-rank test)

Summary

Introduction

Heart failure (HF) is a global public health problem characterized by high mortality and increased hospitalization rates [1]. Patients discharged directly from the ED have the highest risk of short-term adverse outcomes [3]; these subjects show high mortality, increased re-hospitalization rates leading to lower quality of life, and increased healthcare costs [4]. We chose to adopt the EHMRG score, since it was designed in the ED to assess short-term mortality for AHF [11], ensuring a patient’s risk stratification since their arrival. It was validated in different populations with similar results [15,16]. In a population of elderly subjects admitted for AHF, whether a sequential approach based on an initial EHMRG evaluation, and a subsequent risk stratification based on an echocardiographic marker, namely TAPSE/PASp, was able to identify patients at lower risk of short-term mortality among subjects classified as in moderate-to-high risk according to EHMRG score classification

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