Retrospective evaluation of echocardiographic variables for prediction of heart failure hospitalization in heart failure with preserved versus reduced ejection fraction: A single center experience.

Michael M Hammond,Dhruv S Kazi,Lawrence J Markson,Sherif F Nagueh,Allan L Klein,Changyu Shen,Warren J Manning,Jordan B Strom,A Reshad Garan,Stephanie Li,Marwa A Sabe,Vincenzo Lionetti

doi:10.1371/journal.pone.0244379

Abstract

BackgroundLimited data exist on the differential ability of variables on transthoracic echocardiogram (TTE) to predict heart failure (HF) readmission across the spectrum of left ventricular (LV) systolic function.MethodsWe linked 15 years of TTE report data (1/6/2003-5/3/2018) at Beth Israel Deaconess Medical Center to complete Medicare claims. In those with recent HF, we evaluated the relationship between variables on baseline TTE and HF readmission, stratified by LVEF.ResultsAfter excluding TTEs with uninterpretable diastology, 5,900 individuals (mean age: 76.9 years; 49.1% female) were included, of which 2545 individuals (41.6%) were admitted for HF. Diastolic variables augmented prediction compared to demographics, comorbidities, and echocardiographic structural variables (p < 0.001), though discrimination was modest (c-statistic = 0.63). LV dimensions and eccentric hypertrophy predicted HF in HF with reduced (HFrEF) but not preserved (HFpEF) systolic function, whereas LV wall thickness, NT-proBNP, pulmonary vein D- and Ar-wave velocities, and atrial dimensions predicted HF in HFpEF but not HFrEF (all interaction p < 0.10). Prediction of HF readmission was not different in HFpEF and HFrEF (p = 0.93).ConclusionsIn this single-center echocardiographic study linked to Medicare claims, left ventricular dimensions and eccentric hypertrophy predicted HF readmission in HFrEF but not HFpEF and left ventricular wall thickness predicted HF readmission in HFpEF but not HFrEF. Regardless of LVEF, diastolic variables augmented prediction of HF readmission compared to echocardiographic structural variables, demographics, and comorbidities alone. The additional role of medication adherence, readmission history, and functional status in differential prediction of HF readmission by LVEF category should be considered for future study.

Highlights

Heart failure (HF) is a significant public health problem accounting for nearly 1 million hospitalizations annually in developed countries with estimates expected to increase by >8 million people in the US by 2030, accounting for nearly $70 billion in costs [1,2,3,4,5,6]
Prediction of heart failure (HF) readmission was not different in HFpEF and HFrEF (p = 0.93). In this single-center echocardiographic study linked to Medicare claims, left ventricular dimensions and eccentric hypertrophy predicted HF readmission in HFrEF but not HFpEF and left ventricular wall thickness predicted HF readmission in HFpEF but not HFrEF
Regardless of LV ejection fraction (LVEF), diastolic variables augmented prediction of HF readmission compared to echocardiographic structural variables, demographics, and comorbidities alone

Summary

Introduction

Heart failure (HF) is a significant public health problem accounting for nearly 1 million hospitalizations annually in developed countries with estimates expected to increase by >8 million people in the US by 2030, accounting for nearly $70 billion in costs [1,2,3,4,5,6]. While many echocardiographic variables such as left ventricular (LV) wall thickness, mass, and chamber sizes, have been associated with an adverse prognosis in individuals with prior heart failure hospitalization [8], only a few studies have evaluated the ability of these variables to predict HF readmission in a mixed systolic function cohort [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23]. Limited data exist on the differential ability of variables on transthoracic echocardiogram (TTE) to predict heart failure (HF) readmission across the spectrum of left ventricular (LV) systolic function

Methods

Results

Discussion

Conclusion