Abstract
Introduction
Acute heart failure (AHF) is frequently associated with congestion leading to elevation of cardiac filling pressure. The present study investigates echocardiographic parameters of diastolic function in patients with AHF or non-AHF aetiology of acute dyspnoea.
Purpose
To determine the patterns of diastolic dysfunction in different profiles of acute dyspnoea.
Methods
Prospective multicentre observational study included 1455 acutely dyspnoeic patients in emergency departments from 2015 to 2017. Echocardiography was performed during the first 48 hours in 452 (31%) patients assessing left ventricular (LV) parameters. They were compared in four patient profiles based on dyspnoea cause and history of chronic HF (CHF): 1) AHF; 2) acute coronary syndrome without adjudicated AHF (Non-AHF+ACS); 3) non-AHF with CHF (Non-AHF+CHF); 4) other non-AHF patients (Non-AHF+other). Data were analysed using R statistical package.
Results
Significant differences in LV morphology and function were observed in the groups (Table 1). Increased LV filling pressure (E/E' >13) was found in most of AHF and Non-AHF+ACS patients, and in around 1/4 of Non-AHF+CHF group. Furthermore, more pronounced left-sided remodelling was observed in the first two groups. 1/3 of AHF patients had restrictive pattern of LV filling. Normal filling pressure dominated in Non-AHF+CHF and Non-AHF+other subgroups.
LV parameters in acute dyspnoea profiles Parameter AHF (n=291) Non-AHF + ACS (n=43) Non-AHF + CHF (n=44) Non-AHF + other (n=74) p value Age, years 71 [62–78] 72 [64–78] 71 [65–80] 68 [56–74] 0.045 LVEF, % 38 [25–55] 47 [32–55] 55 [45–55] 55 [50–55] <0.001 LV MMI, g/m2 126 [104.6–150.4] 99.1 [82.9–124] 94.4 [78.3–108.6] 79.6 [70.7–99.4] <0.001 LAVi, cm3 61.7 [50.9–81.1] 40.4 [35.5–46.8] 43.2 [39.8–58.9] 37.2 [32.6–43.8] <0.001 E/E' >13, % 57.7% 57.1% 23.1% 2.9% <0.001 E/E' <10, % 23.4% 38.1% 76.9% 70.6% <0.001 E/A >2, % 34.4% 14.8% 12.5% 3.9% <0.001 E/A <1, % 30.3% 59.3% 66.7% 74.5% <0.001 LVEF, left ventricular ejection fraction; LVdd, left ventricular diastolic diameter; LV MMI, left ventricular myocardial mass index; LAVi, left atrial volume index; AHF, acute heart failure; ACS, acute coronary syndrome; CHF, chronic heart failure.
Conclusions
Our data confirm the predominance of an increased cardiac filling pressure in acute heart failure patients, differently from chronic heart failure patients admitted due to other causes of dyspnoea. Patients with dyspnoea due to acute coronary syndrome frequently demonstrate elevated left-sided filling pressure.
Acknowledgement/Funding
The work was supported by the Research Council of Lithuania, grant Nr. MIP-049/2015 and approved by Lithuanian Bioethics Committee, Nr. L-15-01.
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