Decompensated Heart Failure Research Articles

Endothelial Markers in Type 2 Diabetic Patients with Acute Decompensated Heart Failure: A Pilot Study

Background: Impaired endothelial function has been associated with vascular complications in type 2 diabetes (T2D), but its role in T2D-related heart failure (HF) remains indeterminate. The aim of this study was to assess selected markers of endothelial function in T2D patients with acute decompensated HF. Methods: A pilot prospective study on patients with acute decompensated HF requiring in-hospital admission was carried out. The vascular endothelial growth factor (VEGF), intercellular adhesion molecule 1 (ICAM-1), and vascular cell adhesion molecule 1 (VCAM-1) were assessed at admission and after decongestion. Subsequently, differences in these markers between T2D and non-diabetic (ND) patients were studied. Results: In total, 39 patients (21 with T2D and 18 ND patients) were enrolled. Twenty-eight patients presented with preserved ejection fraction (EF), and 11 presented with reduced EF. Looking at the VEGF levels in T2D patients, on admission, a median of 233.0 pg/mL (1.7–598 pg/mL) was found compared to 106.0 pg/mL (1.7–888 pg/mL) in ND individuals; the differences reached statistical significance (p = 0.04). There were no significant differences in VEGF levels after decongestion, and in VCAM-1 (2237 ± 1195 vs. 2699 ± 1093 ng/mL, p = 0.37) and ICAM-1 (596 ± 268 vs. 638 ± 437 ng/mL, p = 0.79) levels between T2D and ND patients upon admission and after decongestion. The value of EF (preserved or reduced) affected the VEGF levels upon admission. Conclusions: This study identified significantly higher VEGF levels upon admission due to acute decompensated HF in T2D patients.

Assessment of relationship between red blood cell distribution width and renal function in patients with acute heart failure

Objectives: To investigate the association between Red Blood Cell Distribution Width (RDW) and renal function in patients experiencing acute decompensated heart failure (ADHF). Methods: A retrospective analysis was conducted on the medical records of 254 patients admitted to Seyyed Al-Shohada Hospital in Urmia, Iran, between July 2021 and July 2023. Patients' RDW values and Glomerular Filtration Rate (GFR) were analyzed using statistical methods. Results: The study revealed a significant inverse relationship between RDW and GFR. Patients with elevated RDW levels (greater than 14.5%) demonstrated reduced GFR values compared to those with lower RDW levels. The mean GFR in patients with RDW ≤14.5% was 59.31 ml/min, while in patients with RDW >14.5% it was 49.71 ml/min (p < 0.001). Conclusions: RDW is an important biomarker for evaluating renal function and predicting outcomes in ADHF patients. RDW inclusion in evaluating ADHF patients could improve risk stratification and facilitate early intervention. Additional studies are necessary to validate these findings and examine the underlying mechanisms. RDW Integration into routine clinical practice may enhance the identification of patients at higher risk for renal complications, enabling timely therapeutic interventions and potentially improving overall patient management and outcomes.

Phenotypic Trajectories From Acute to Stable Phase in Heart Failure With Preserved Ejection Fraction: Insights From the PURSUIT-HFpEF Study.

Using machine learning for the phenotyping of patients with heart failure with preserved ejection fraction (HFpEF) has emerged as a novel approach to understanding the pathophysiology and stratifying the patients. Our objective is to perform phenotyping of patients with HFpEF in stable phase and to investigate the phenotypic trajectory from acute worsening phase to stable phase. The present study is a post hoc analysis of the PURSUIT-HFpEF (Prospective Multicenter Observational Study of Patients with Heart Failure with Preserved Ejection Fraction) study. We applied the latent class analysis to the discharge data of patients hospitalized for acute decompensated heart failure. We finally included patient data of 1100 cases and 63 features in the latent class analysis. All patients were subclassified into 5 phenogroups as follows: Phenotype 1, characterized by better renal function and lower NT-proBNP (N-terminal pro-B-type natriuretic peptide) level [N=325 (29.5%)]; Phenotype 2, higher blood pressure, sinus rhythm, and poor renal function. [N=242 (22.0%)]; Phenotype 3, higher prevalence of atrial fibrillation, higher tricuspid pressure gradient, and lower tricuspid annular plane systolic excursion [N=214 (19.5%)]; Phenotype 4, higher C-reactive protein level and higher tricuspid pressure gradient [N=245 (22.3%)]; and Phenotype 5, poor nutritional status, poor renal function, and higher NT-proBNP level [N=74 (6.7%)]. A particular phenotype observed at the time of discharge was correlated with a distinct phenotype of acute worsening. We identified 5 distinct stable phase phenotypes of the patients with HFpEF from the data at discharge. A specific phenotype at discharge was associated with a particular phenotype of acute worsening. This grouping can be a basis for future precision medicine of patients with HFpEF. URL: https://www.umin.ac.jp/ctr/; Unique identifier: UMIN000021831.

Safety and Tolerability of Initiating Sacubitril-Valsartan With Spironolactone During Hospitalization for Acute Decompensated Heart Failure

Background: Initiation of sacubitril-valsartan and mineralocorticoid receptor antagonists (MRA) during hospitalization for acute decompensated heart failure (ADHF) may be an ideal time to optimize guideline-directed medical therapy. However, there is limited research assessing the safety of combining these agents in the hospital. Methods: This was a multi-center, retrospective, propensity-score matched cohort study performed at 7 acute-care hospitals within a large health care system. All adult patients admitted with ADHF between January 1, 2019 to December 31, 2021 who received sacubitril-valsartan with MRA (MRA group) or without MRA (non-MRA group) and had a left ventricular ejection fraction (LVEF) < 40% were included in the study. Results: 220 patients were screened during the study time frame with 179 meeting inclusion criteria. Following propensity-score matching, 50 patients in the MRA group were matched to 50 patients in the non-MRA group. The overall incidence of adverse drug reactions (ADRs) was 24% in the non-MRA group compared to 20% in the MRA group (P = .629). There was a significantly greater incidence of hyperkalemia in the MRA group (0% vs 10%; P = .022). None of the patients in the non-MRA group were readmitted within 30 days due to an ADR compared to 6% in the MRA group (P = .079). Conclusion: The addition of spironolactone to sacubitril-valsartan in the hospital setting following stabilization of ADHF did not lead to a significantly greater incidence of overall ADRs, but patients were more likely to develop hyperkalemia and there was a numerically higher incidence of 30-day readmissions due to ADRs.

Treatment dilemma in acute decompensated heart failure and untreated Grave disease

Treatment dilemma in acute decompensated heart failure and untreated Grave disease

Designing Effective Trials for Acute Decompensated Heart Failure

Designing Effective Trials for Acute Decompensated Heart Failure

Remote monitoring in patients with heart failure and ventricular dysfunction: operating protocol of Trieste Cardiology

Chronic heart failure is a condition characterized by an increasing epidemiological impact, ranking among the leading causes of morbidity and mortality, and often requiring complex and costly outpatient and hospital management. Patients with heart failure with reduced left ventricular systolic function who have implantable cardiac defibrillators with or without cardiac resynchronization therapy can now benefit from innovative telemonitoring algorithms designed to predict acute decompensated heart failure and to promote early prevention and treatment strategies. Composite indices generated by devices from Boston Scientific (HeartLogic™), Biotronik (HeartInsight), and Medtronic (TriageHF), through multiparametric scores and specific alert notifications, indicate hemodynamic changes in the subclinical and often asymptomatic phase with high sensitivity and specificity, forewarning of acute destabilizations. This review proposes an organizational model aimed at an integrated and coordinated management of heart failure alerts between the hospital (particularly the Pacemaker and the Heart Failure Clinic of Cardiology in Trieste) and the regional Cardiology network, following uniform diagnostic and therapeutic criteria. By drafting a management protocol, our Cardiology department monitors heart failure patients with reduced systolic function using a flowchart that categorizes patients by risk of acute events, starting from the alert and a simple phone contact. Stable patients are monitored remotely for 2 weeks until the heart failure alert resolves, but if the alert persists, they are referred to the Heart Failure section or regional Cardiology for further management. In-alert patients with two or more objective signs/symptoms of heart failure are provided with educational and behavioral advice and have their current therapy adjusted, with remote follow-up every 15 days. If the alert persists for more than 2 weeks after onset, the case is forwarded to the Heart Failure section for a phone reassessment and further investigation, including blood tests and NT-proBNP level measurements.

Determinants of cost discrepancies in inpatients with acute decompensated heart failure

BACKGROUND: Acute decompensated heart failure (ADHF) is a prevalent and complex condition that significantly burdens healthcare systems, requiring intensive care and leading to high treatment costs. OBJECTIVES: This study aims to identify factors influencing cost discrepancies in hospitalized ADHF patients. METHODS: This retrospective study was conducted at Universitas Brawijaya Hospital from July to August 2024. Data were collected from 86 ADHF patients who were hospitalized between January 2021 and December 2023. Information regarding the patients' clinical conditions, comorbidities, and medical procedures was extracted from their case histories. Statistical analyses included t-tests and Mann-Whitney tests. RESULTS: In this study of 86 individuals with ADHF, 58.1% were over 65 years old, 31.4% were between 45 and 64 years old, and 10.5% were between 18 and 44 years old. By classification of care, 58.1% were admitted for Class 1 care, 30.2% for Class 2, and 11.6% for Class 3. Our findings indicated that the costs of treatment for patients with moderate and severe diseases were higher as compared to those of mild severity. Patients who had a length of stay over 7 days had higher costs than the ones whose length of stay was 1 to 3 days. Furthermore, Class 2 care was associated with higher costs than Class 3 care. The analysis also revealed that an increase in the number of comorbidities and medical procedures corresponded with higher treatment costs. CONCLUSION: This study identified factors that increase the cost of treatment for patients with ADHF. Keywords: Acute decompensated heart failure, treatment costs, comorbidities, length of stay

Age-Specific Changes in Physical Function in Patients with Acute Decompensated Heart Failure

Cardiac rehabilitation (CR) improves physical function in patients with acute decompensated heart failure (ADHF) and frailty. However, few studies have assessed physical function through multiple measures during hospitalization; moreover, the effect of age remains unclear. This study aimed to evaluate age-specific changes in physical function during the acute-phase treatment period in patients with ADHF. Patients with ADHF hospitalized between June 2018 and June 2023, who were aged ≥ 60 years and underwent CR, were included in the study. Physical function assessments at admission and discharge included grip strength, quadriceps isometric strength, short physical performance battery (SPPB), gait speed, and frailty. Changes in physical function from admission to discharge were assessed. The mean age of the 531 patients was 79.8 ± 9.0 years and 58% were male. Physical function at admission and discharge significantly decreased with age according to all measures. In patients aged ≥ 90 years, quadriceps isometric strength (0.27 ± 0.11 kgf/BW kg) and the SPPB score (4.5 ± 3.6 points) were severely impaired at admission. However, no significant differences were observed in changes in physical function according to age; the improvement in the SPPB score tended to increase with age (+1.7 ± 1.9, +2.3 ± 2.1, +2.2 ± 2.4, and +2.3 ± 1.8, in the 60-69-, 70-79-, 80-89-, and ≥ 90-year age groups, respectively). The improvement in frailty was similar in all groups. Although physical function declined with age, the changes in physical function were similar in patients with ADHF at any age above 60 years who underwent CR.

Randomized trial to assess worsening renal function by adding dapagliflozin for acute decompensated heart failure.

Dapagliflozin (DAPA), a sodium-glucose co-transporter 2 inhibitor, has been shown to reduce cardiovascular mortality among patients with chronic heart failure. We aimed to evaluate the impact on a worsening renal function (WRF) by adding DAPA as compared to standard decongestive therapy with loop diuretics alone. We enrolled 114 consecutive acute decompensated heart failure (ADHF) patients with a left ventricular ejection fraction (LVEF) of less than 50%. The patients were prospectively randomized to be assigned either to DAPA group who received DAPA at a dose of 10mg once daily within 24h after admission or conventional therapy group (CON group) who received loop diuretics alone. All patients were adjusted by increasing or decreasing the loop diuretic by 10mg to maintain a 1-2mL/kg/h urine output. The primary endpoint was the incidence of WRF, which was defined as an increase in the serum creatinine of ≥0.3mg/dL from baseline. The median age of the patients was 77 [interquartile range (IQR): 64, 85] years, 35% were female and the median LVEF was 33 [IQR: 28, 38] %. There was no significant difference in the incidence of WRF between the two groups (16.1%, n=9 vs. 12.1%, n=7, P value=0.54). The total dose of loop diuretics through day 7 was lower in the DAPA group than CON group (184±79.5mg vs. 214±66.5mg, P value=0.03). This randomized prospective trial revealed the addition of DAPA within 24h after admission reduced the diuretic dose without WRF.

Errata: Phenogroups and Their Prognosis of Acute Decompensated Heart Failure with Preserved Ejection Fraction

Several errors (shown with underlines) in the following list appeared in the article "Phenogroups and Their Prognosis of Acute Decompensated Heart Failure with Preserved Ejection Fraction" by Taro Makino, Yuya Ishihara, Masahide Harada, Yoshihiro Sobue, Eiichi Watanabe, Yukio Ozaki, Hideo Izawa (Vol. 65 No.5, 841-848, 2024).

Personalized app-based coaching for improving physical activity in heart failure with preserved ejection fraction patients compared with standard care: rationale and design of the MyoMobile Study

Abstract Aims Patients suffering from heart failure with preserved ejection fraction (HFpEF) often exhibit a sedentary lifestyle, contributing to the worsening of their condition. Although there is an inverse relationship between physical activity (PA) and adverse cardiovascular outcomes, the implementation of Class Ia PA guidelines is hindered by low participation in supervised and structured programmes, which are not suitable for a diverse population of HFpEF patients. The MyoMobile study has been designed to assess the effect of a 12-week, app-based coaching programme on promoting PA in patients with HFpEF. Methods and results The MyoMobile study was a single-centre, randomized, controlled three-armed parallel group clinical trial with prospective data collection to investigate the effect of a personalized mobile app health intervention compared with usual care on PA levels in patients with HFpEF. Major inclusion criteria were age ≥ 45 years, a diagnosis of HFpEF, LVEF &amp;gt; 40%, and current HF symptoms (NYHA Class I–III). Major exclusion criteria included acute decompensated HF, non-ambulatory status, recent acute coronary syndrome or cardiac surgery, alternative diagnoses for HF symptoms, active cancer treatment, and physical or medical conditions affecting mobility. Participants were recruited from hospitals, general practices, and practices specialized in internal medicine and cardiology in the Rhine-Main area, Germany. Participants underwent an objective 7-day PA measurement with a 3D accelerometer (Dynaport, McRoberts) at screening and after the 12-week intervention period. Following the screening, eligible participants were randomized into one of three groups: standard care (PA consulting), the intervention arm with app-based PA tracking and coaching, or the intervention arm with tracking but without coaching. The primary efficacy endpoint was the change in average daily step count between the average step count at baseline and at the end of the intervention, comparing standard care to a 12-week app-based PA coaching intervention. Conclusion Exercise intolerance is a primary symptom in HFpEF patients, leading to poor quality of life and HF-related adverse outcomes due to physical inactivity. The MyoMobile study was designed to investigate the use of app-based coaching to improve PA in patients with HFpEF with a personalized, home-based intervention, focusing on simple step counts for flexibility and ease of integration into daily routines. Clinical trial registration URL: https://clinicaltrials.gov/ct2/show/NCT04940312. Unique identifier NCT04940312.

Peak atrial longitudinal strain identifies patients with acute decompensated heart failure at high risk of cardiac death

Abstract Background Heart failure (HF) is an increasing health problem with high morbidity and mortality. Left atrial function has prognostic relevance in long-term survival of patients with HF. However, its prognostic value in patients with acute decompensated heart failure (ADHF) is less well studied. Objective The main objective of this study was to assess the association between PALS (peak atrial longitudinal strain) and cardiovascular (CV) death in patients ADHF. Methods A prospective single center study was performed. We enrolled patients admitted with ADHF according to the current European guidelines criteria. Clinical and biochemical data were collected. Echocardiography was performed during the first 24 hours of admission including quantification of left ventricular, right ventricular and left atrial function. Patients were followed up during hospitalization and at discharge. PALS was quantified by a single vendor equipment, using four and two chamber dedicated left atrial views and semi-automated software. The primary outcome was cardiovascular death at 3 years of follow-up. Variables were compared between patients with and without cardiovascular death. A ROC curve was constructed to define the best cut-off point, sensitivity, and specificity of PALS to predict the primary outcome. Results Sixty patients were included. The median age was 58 (24-90) years, 26% were female. Median NT-PRO BNP 5168 (186-70000) pg/mL, Creatinine clearance 70.6 ± 31.1 ml/min, hemoglobin 14.6 (1.5-19.3) g/dL. Left ventricular indexed end-diastolic volume 74.8 (26.8-181) ml/m2, left ventricular indexed end-systolic volume 51.4 (6.7-170.6) ml/m2, left ventricle ejection fraction 62.2 ± 13.6 %. Patients with cardiovascular death during follow-up, had lower LVEF 24 ± 8.3 vs 33.9 ± 13.8 % (p&amp;lt;0.033) and lower PALS 7.2 (4-14) vs (17 (3-39) %;(p&amp;lt; 0.002). In the ROC curve analysis, in the best-case scenario, an atrial strain value lower than 12% had a sensitivity of 72% and 90% of specificity for predicting cardiovascular death. Survival analysis demonstrated better survival in patients with PALS higher than 12%. Conclusions Left atrial strain is useful in patients with ADHF to identify patients at higher risk of cardiac death. According to our results, patients with PALS lower than 12% constitute a high-risk group in whom a closer follow-up and intensive treatment might be needed. Future studies are needed to confirm our findings. Survival according to PALS in ADHF

Prognostic value of echocardiography-based right ventricular-pulmonary artery coupling estimation in acute decompensated heart failure

Abstract Background Right ventricular-pulmonary artery coupling (RV-PA coupling) represents the relationship between RV contractility and RV afterload. RV-PA uncoupling occurs when RV contractility cannot increase to match RV afterload. This leads to RV dysfunction and right heart failure in the end. The value of RV-PA uncoupling in patients with chronic heart failure with reduced and preserved ejection fraction as a determinant of clinical status and strong predictor of cardiovascular death, rehospitalization for heart failure was demonstrated by literature worldwide. However, there are few studies estimated RV-PA uncoupling prognostic value in patients with acute decompensated heart failure (ADHF) upon admission. Purpose To assess echocardiographic parameter of RV-PA coupling and its prognostic value in patients with ADHF. Methods A single-centre observational study included 171 patients admitted to the city clinical hospital with ADHF (51.5% male, 70 (62;80) years old, arterial hypertension 93%, previous myocardial infarction 39.8%, HF with preserved ejection fraction (HFpEF) 36.8% (n=63), HF with reduced EF (HFrEF) 41.5% (n=71), HF with mid-range EF (HFmrEF) 21.6% (n=37), diabetes 36.8%, NYHA functional class III – 52.1%, class IV – 40.2%, NTproBNP 1683 (830;2944) pg/ml, serum creatinine 105 (86;126.4) µmol/l, eGFR 54.2 (44.1;67.8) ml/min/1.73 m2, potassium 4.5 ± 0.7 mmol/l, echocardiography parameters - left ventricle ejection fraction (LVEF) 44 (30;55)%, pulmonary artery systolic pressure (PASP) 51.2±17.3 mmHg, tricuspid annular plane systolic excursion (TAPSE) 15.4±4.7mm. RV-PA coupling estimated by the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) ratio was evaluated upon admission using two-dimensional echocardiography. TAPSE/PASP &amp;lt; 0.36 mm/mmHg was considered as RV-PA uncoupling. Survival analysis was perfomed using Kaplan-Meier curves. Differences were considered statistically significant when p &amp;lt;0.05. Results A statistically significant impact of RV-PA uncoupling on hospitalization, estimated by echocardiography, for heart failure (HF) and for all-cause hospitalization was revealed. Among patients with RV-PA uncoupling the risk of hospitalization for HF increased by 25% (RR 1.251; 95%CI: 1.020-1.539, p=0.042), and the risk of all-cause hospitalization - by 20-24% (RR 1.240; 95% CI: 1.001-1.537; p=0.049). Hospitalization rates for HF (OR 2.07; 95%CI: 1.02–4.02; p=0.042) and all-cause hospitalization (OR 1.96; 95%CI: 1.00–3.86; p=0.049) were 2 times higher. Conclusion: The identified prognostic value of echocardiography-based RV-PA uncoupling estimation in ADHF regardless of phenotype indicates the advisability of its assessment upon hospitalization. TAPSE/PASP can serve as an important simple tool for risk stratification of patients, optimizing their management and improving the long-term survival of patients.

Myocardial stiffness decreases in decompensated heart failure patients after recompensation

Abstract Background Cardiac shear wave elastography (SWE) allows for the non-invasive assessment of myocardial stiffness via the detection of shear waves (SW) travelling through the heart after e.g. mitral valve closure (MVC). The propagation speed of these waves is directly related to myocardial stiffness. Myocardial operational stiffness depends on the intrinsic properties of the myocardium as well as the loading conditions of the heart. Therefore, changing loading conditions, for example volume unloading under diuretics, could influence SW speed. Purpose To evaluate the effect of volume unloading on shear wave speed in patients with decompensated heart failure before and after intravenous diuretics. Methods Eleven patients with decompensated heart failure were included. SWE was performed in the first hours after they presented at the emergency room and a few days later before discharge of the hospital. In between, all patients had received intravenous diuretics. For SWE, tissue doppler imaging of the LV parasternal long axis view was acquired at a high frame rate (1048±97 fps) using a research ultrasound scanner. SWs after mitral valve closure were visualized in M-modes of the septum, colour coded for tissue acceleration (fig A). The slope of the shear waves in the M-mode represents their propagation speed. SW speeds were measured in a semi-automatic manner. Results Patient characteristics are described in table 1. There was a significant decrease in weight (80.6±17.6kg vs 76.7±15.9kg, p&amp;lt;0.001) and tricuspid regurgitant velocity (3.4±0.5m/s vs 2.8±0.7m/s) before discharge, indicating a decrease in volume overload. Ejection fraction, global longitudinal strain and E/e’ did not significantly change between admittance and discharge. E/A ratio is not described, as most patients had atrial fibrillation. SW speed was significantly higher in the decompensated state upon admission than right before discharge (7.3±1.8m/s vs 5.4±1.4m/s, p&amp;lt;0.001; Fig B). A borderline correlation was observed between the difference in shear wave speed and weight loss between admission and discharge (r=0.53; p=0.09; Fig C). Although this was not significant, likely due to the limited size of the study population, it seems that SW speed decreases with decreasing volume overload. Furthermore, a borderline correlation was seen between shear wave speed and pro-BNP at admittance (r=0.60; p=0.085; Fig D), possibly indicating that there is a link between increased shear wave speed and increased filling pressures. Conclusion SW speed at mitral valve closure significantly decreased with decreasing volume overload in patients with decompensated heart failure. We hypothesize, that unloading the LV causes a leftward shift on the end-diastolic pressure-volume-relation and with this a decrease in in end-diastolic myocardial stiffness. SWE might become an interesting tool to non-invasively evaluate diastolic properties of the LV. Table 1 Figure 1

Prognostic significance of predischarge echocardiography in acute decompensated heart failure

Abstract Introduction Current guidelines do not specify the timing of echocardiography during acute decompensation of heart failure (HF). In particular, the question of the usefulness of an echocardiographic imaging immediately before discharge from the hospital, i.e. after achieving hemodynamic stabilization, remains unresolved. Aim To compare the prognostic value of echocardiography performed on admission and discharge in patients hospitalized due to acute HF decompensation, and to identify which echocardiographic markers may predict a poor early outcome after discharge. Methods A complete echocardiogram, comprising assessment of myocardial deformation and myocardial work: global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) was performed twice- upon admission and upon discharge from the hospital in 130 patients (67±15 years of age, mean EF 35±15%) with decompensated HF (NYHA class III or IV). HFpEF was diagnosed in 26, HFmrEF in 19, and HFrEF in 85 enrollees. Participants were followed over 6 weeks after discharge for death and HF hospitalization (composite end-point). Results HF hospitalization or death occurred in 18 patients (13 and 5, respectively). Among echocardiographic parameters of left ventricular (LV), left atrial and right ventricular (RV) function, only E/e’ and GWW measured at pre-discharge were associated with the composite end-point, and the significance of these associations was retained when both predictors were included in the bivariable model. (Table). No associations with the study endpoint were found for any of the echo parameters measured at admission. Conclusions In patients with acute decompensated HF: 1) predischarge echocardiography after achieving hemodynamic stabilization can provide more short-term prognostic information than admission echocardiography during hemodynamic worsening; 2) in addition to LV filling pressure estimation (E/e’), measurement of LV myocardial work may improve the prediction of early mortality and HF readmission after hospital discharge. Table

Prognostic utility of non-invasive left atrial stiffness index in patients with heart failure with preserved ejection fraction: insights from EASY-HFpEF study

Abstract Background It is known that an increase left atrial stiffness is associated with poor prognosis in patients with heart failure with preserved ejection fraction (HFpEF). Purpose We evaluated the predictive utility of non-invasive left atrial stiffness index (LASI) in HFpEF patients, comparing it to other clinical prognostic indicators. Methods Patients were recruited from the EASY-HFpEF study, a multicenter prospective observational cohort study in Japan involving patients hospitalized with acute decompensated heart failure and a left ventricular ejection fraction of &amp;gt;40%. Among the patients in the study, those with registered echocardiographic image data of sufficient quality were analyzed for left atrial strain. The LASI was calculated as the ratio of E/e’ to the left atrial reservoir strain. The primary endpoint was a composite outcome of all-cause death and readmission due to heart failure during the 2-year follow-up period. Results We analyzed 95 patients, with a median age of 75 years and including 41% female patients. LASI was associated with an increased risk of composite outcome (adjusted HR 1.10 [95%CI; 1.04-1.17, P=0.001] per 0.1 increase). LASI was non-inferior in predictive ability compared to predictors such as B-type natriuretic peptide (BNP) and H2FPEF score. (AUCLASI=0.79, AUCBNP=0.80 [vs.AUCLASI, P=0.775], AUCH2FPEF =0.75 [vs.AUCLASI, P=0.342]) (Figure 1). The addition of LASI significantly improved the prognostic power of a model containing BNP and H2FPEF score (model of BNP+H2FPEF score, χ2=29.3; model of BNP+H2FPEF+LASI, χ2=40.5, P=0.004) (Figure 2). Conclusion Non-invasive LASI in HFpEF patients is associated with increased risks of all-cause mortality and heart failure readmission, its potential utility in predicting these adverse events.

Prognostic value of TAPSE/RVSP ratio in patients with acute heart failure: a prospective observational cohort study

Abstract Background/Introduction The tricuspid annular plane systolic excursion (TAPSE)/right ventricular systolic pressure (RVSP) ratio, derived from echocardiography, has been proposed as a valid, non-invasive surrogate of the right ventricle-pulmonary artery coupling in heart failure (HF), demonstrating strong prognostic utilities in stable patients with chronic HF and preserved or reduced ejection fraction (EF). However, there are scarce data in patients with acute HF. Purpose The aim of the current study was to investigate the prognostic role of the TAPSE/RVSP ratio in adult patients hospitalised for acute HF in our Cardiology department. Methods This was a prospective observational cohort study of consecutive adult individuals who experienced an acute de novo HF event or had acute decompensated HF between August 2023 and June 2024. An independent investigator conducted a comprehensive transthoracic echocardiogram within the first 24 hours since admission and each patient was classified as having HF with reduced, mildly reduced or preserved EF according to the ESC guidelines. Moreover, the TAPSE/RVSP ratio was calculated according to the EACVI guidelines. All-cause mortality or HF re-hospitalisation was defined as the primary composite outcome and each patient was followed until the 20th of June or until the composite outcome occurred. TAPSE/RVSP ratio was divided in tertiles (≤0.30, 0.31-0.40, &amp;gt;0.40). Kaplan-Meier curves as well as univariate and multivariable cox regression analyses were used for data analysis and presentation. Results In total, 143 patients with acute HF (mean age 82 years, 58% female) were included in the study. Of those, 36% were diagnosed as having acute de novo HF. Half of total patients were classified as HF with preserved EF. Mean right ventricular diameter was 40 ± 8 mm and mean TAPSE was 15.4 ± 3.7 mm. During a median follow-up of 123 days, the composite outcome occurred in 36% of patients (n=52). By Kaplan-Meier analysis, individuals in the lowest tertile (TASPE/RVSP ratio ≤0.30) showed the lowest freedom from the composite outcome (Figure 1; p &amp;lt;0.0001, log-rank test). In multivariable regression analysis, TAPSE/RVSP ratio ≤0.30 was associated with a 14-fold risk of all-cause mortality or HF re-hospitalisation (Figure 2; adjusted hazard ratio: 14.7; 95% CI: 2.5, 85.3; p=0.002). Conclusions In patients hospitalised for acute HF, a statistically significant association between the TAPSE/RVSP ratio and the composite outcome was found. Those patients with TAPSE/RVSP ratio ≤0.30 had a 14-fold risk of all-cause mortality or HF re-hospitalisation. Kaplan-Meier curves Multivariable Cox regression analysis

Accuracy of nursing diagnoses identified at admission and discharge of patients with decompensated heart failure.

To determine the accuracy of nursing diagnoses at hospital admission and discharge for patients with heart failure (HF). This comparative study examined the documentation in 155 medical records of patients with an admitting diagnosis of HF during August 2018 and July 2019. An audit tool was used to record the diagnoses made by nurses during routine care at the time of admission and discharge. Two researchers (L.S. and A.C.) examined the records and evaluated the documented nursing diagnoses using the Nursing Diagnosis Accuracy Scale version 2. Kappa was used for agreement between them. Patient social and clinical characteristics were described using percentages, absolute frequencies, means, and standard deviations. A total of 18 unique nursing diagnoses were identified across the 155 patients. Among the 754 nursing diagnoses recorded, 85% of those identified at admission (n=644) were deemed highly accurate. At discharge, of the 527 diagnoses recorded, 66% (n=349) were rated as highly accurate. Excess fluid volume was the most common diagnosis (85% at admission, 49% at discharge). Three risk diagnoses were frequent at both points: risk for infection, risk for falls, and risk for decreased cardiac output. Agreement between evaluators ranged from Κ=0.234 to 1.00. Greater agreement in nursing diagnoses at discharge likely reflects ongoing patient monitoring. Persistent diagnoses at discharge highlight the need for continued nursing care post-discharge. This study encourages nurses to improve clinical evaluation for HF patients from admission to discharge. As key clinical indicators are identified, nurses can improve the accuracy of their diagnoses and plan more effective interventions to achieve positive health outcomes and reduce unnecessary hospitalization.

Echocardiographic estimation of cardiovascular energy transfer in patients with heart failure: an explorative study

Abstract Background Heart failure (HF) is a complex and debilitating condition. The pathophysiology of HF is related to the dynamic interplay governing the energy transfer from the heart to the vascular bed. This energy transfer can be estimated by calculating the heart's external power, measured in watts, which is the product of flow and pressure divided by time. Although power measurements can potentially improve hemodynamic assessment in patients with heart failure, clinical estimation of cardiovascular energy transfer is rarely used due to cumbersome analyses and dependence on invasive measurements. We propose a novel method based on echocardiography and continuous non-invasive blood pressure measurement to estimate cardiovascular energy transfer. Aim To test whether non-invasive estimates of cardiovascular energy transfer can differentiate between HF patients with reduced and preserved left ventricular ejection fraction (LVEF). Methods We included patients hospitalized with decompensated HF not optimally treated in the study. All patients underwent an echocardiographic examination using a GE HealthCare Vivid E95 scanner. We used the biplane Simpson method to calculate LVEF and the pulsed wave Doppler velocity spectrum in the left ventricular outflow tract to estimate flow. Continuous non-invasive blood pressure measurements were obtained using a Finapres finger cuff device calibrated with the brachial blood pressure. We developed an application for tracing the velocity spectrum, synchronizing flow and pressure curves, and calculating the power curves as the product of continuous synchronized flow and pressure curves. The patients were categorized into two groups based on whether LVEF was &amp;lt; 40% or ≥ 40%. Results We observed that cardiovascular energy transfer, estimated as external power, differed between patients with LVEF &amp;lt;40% vs. ≥40%. The study cohort comprised twenty-eight patients (25% women), averaging 76 years (SD 11). Eighteen patients had LVEF &amp;lt;40%, with a mean LVEF of 27% (SD = 9%), mean velocity time index (VTI) 11.7 cm (SD = 2.94), and) and mean systolic blood pressure 116 mmHg (SD = 19). Ten patients had LVEF ≥40%, with a mean LVEF of 47% (SD = 6 %), VTI 16.5 cm (SD = 5.50), and mean systolic blood pressure 143 mmHg (SD = 20). External power was significantly different between patients with LVEF &amp;lt;40% vs. ≥40%, 0.81 W (SD = 0.21 W) vs. 1.43 W (SD = 0.41 W), respectively, p&amp;lt;0.0001 (Fig. 1). We observed a modest but significant correlation between LVEF and power (R = 0.28, P-value &amp;lt; 0.005). Conclusion Cardiovascular energy transfer, estimated non-invasively as external power, was significantly lower in acutely decompensated heart failure patients with LVEF &amp;lt;40% compared to those with LVEF ≥ 40%. More extensive studies should explore the possible value of estimating cardiovascular energy transfer in stratification and therapeutic decisions in patients with HF.