Prognostic Significance of an Early Echocardiographic Evaluation of Right Ventricular Dimension and Function in Acute Heart Failure

The aim of the paper was to examine the echocardiographic parameters of the right ventricle (RV), its diameter and pulmonary arterial pressure (PAP); to determine their relationship to B-type natriuretic peptide (BNP), troponin and (TnI) and high-sensititity C-raective protein (hsCRP), and to evaluate their prognostic significance to one-year mortality in patients with acute heart failure (AHF). The study included a total of 225 patients (pts) (70.29 ± 9.74 years) who were admitted to Intensive care unit due to the signs and symptoms of AHF. The values of standard biochemical parameters, BNP, TnI and hsCRP were determined during the first 24 hours after admission. All patients underwent echocardiographic examination. During a one-year follow-up, 78 (34.70%) patients died. As compared with the group of survivors (n = 147), the group of non-survivors had higher values of BNP (853.10 ± 384.92 vs. 1399.68 ± 464.44 pg/mL, p < 0.001), TnI (0.59 ± 2.04 vs. 2.00 ± 8.29 ng/ml, p < 0.05), right ventricular diameter and PAP (p < 0.001). BNP was positively correlated with TnI (r = 0.311), PAP (r = 0.255) and right ventricular diameter (r = 0.304, p < 0.001 for all correlations). The cut-off value of BNP ≥ 1062.04 pg/ml, PAP ≥ 44.5 mmHg and TnI ≥ 0.04 ng/ml were associated with a higher risk of mortality. Our results have shown that BNP, PAP and TnI are strong and independent predictors of one-year mortality in hospitalized patients with acute heart failure.

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Prognostic value of biomarkers and co-morbidities in patients with acute heart failure: One-year follow-up study

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh160225030p ◽

2017 ◽

Vol 145 (3-4) ◽

pp. 118-123

Author(s):

Dejan Petrovic ◽

Marina Deljanin-Ilic ◽

Sanja Stojanovic

Keyword(s):

Heart Failure ◽

Renal Failure ◽

Chronic Renal Failure ◽

Acute Heart Failure ◽

Troponin I ◽

Prognostic Significance ◽

Systolic Pressure ◽

High Sensitivity ◽

Clinical Group ◽

One Year

Introduction/Objective. Clinical risk stratification of patients hospitalized due to acute heart failure (AHF) applying B-type natriuretic peptide (BNP), troponin I (TnI), and high-sensitivity C-reactive protein (hsCRP) biochemical markers can contribute to early diagnosis of AHF and lower mortality rates. The aim of this study was to investigate the prognostic significance of biomarkers (BNP, TnI, and hsCRP) and co-morbidities concerning one-year mortality in patients with AHF. Methods. Clinical group comprised 124 consecutive unselected patients, age 60?80 years, treated at the Coronary Care Unit of the Niska Banja Institute, Nis. The patients were monitored for one year after the discharge. During the first 24 hours after admission, BNP, TnI, and hsCRP were measured in fasting serum. Results. Total one-year mortality was 29.8%. The levels of serum BNP were significantly higher in the group of non-survivors compared to the group of survivors (1353.8 ?} 507.8 vs. 718.4 ?} 387.6 pg/mL, p < 0.001). We identified several clinical and biochemical prognostic risk factors by univariate and multivariate analysis. Independent predictors of one-year mortality were the following: BNP, TnI, depression, hypotension, chronic renal failure, ejection fraction, and right-ventricle systolic pressure. Conclusion. The presence of BNP and TnI biomarkers and several co-morbidities such as depression or chronic renal failure have significant influence on one-year mortality in patients with AHF.

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Abstract 14468: Right Heart: Renal Venous Stasis Determinant in Acute Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.14468 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Alessandro Vella ◽

Gianmarco Carenini ◽

Francesco Bandera ◽

Marco Guazzi

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Prognostic Significance ◽

Right Atrial ◽

Venous Stasis ◽

Main Role ◽

Prognostic Impact ◽

Primary Role ◽

Right Heart ◽

The Right

Introduction: The heart-kidney interaction in heart failure (HF) is a matter of special interest, especially due to its strong prognostic significance. The search for a reliable, non-invasive parameter with high pathophysiological and prognostic impact to evaluate HF-related renal congestion remains attractive. Doppler evaluation of intra-renal venous flow (IRVF) has been recently employed in HF patients, with a spectrum of findings ranging from a normal continuous flow to a monophasic discontinuous one, indicative of low and high degrees of renal congestion, respectively. Hypothesis: We postulated a role for right atrial dynamics in the renal congestion pathophysiology. The impairment in atrial deformation and pump function may play a primary role increasing the pulsatile backward load in the venous system, especially in acute heart failure (AHF) patients. Methods: 119 consecutive AHF patients were prospectively investigated within 48 hours from admission. Doppler-derived descriptors of renal hemodynamics included the renal arterial resistive index, IRVF pattern, venous impedance index and renal venous stasis index (RVSI). Results: Right atrial peak longitudinal strain (RAPLS) showed a strong correlation with IRVF pattern (Fig A) and various indices of RV function (TAPSE, S’, FAC) and RV coupling as represented by the TAPSE/PASP ratio (Fig B). At multivariate regression analysis, TAPSE/PASP ratio emerged as the main determinant of RVSI. On the other hand, considering only patients with a clearly impaired RV coupling (TAPSE/PASP <0.30), RAPLS emerged as the best determinant of RVSI (Fig C-D). Conclusions: Our data confirms the main role of the right heart in determining renal stasis in HF patients. When RV to pulmonary circulation uncoupling is severe, the right atrium becomes the key balancing factor in the venous renal flow response. Studies on the mechanistic contribution of the RA dysfunction and the recovery potential of interventions are warranted.

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P1678Feasibility of comprehensive multi-plane echocardiographic evaluation of right ventricular function pre-LVAD implantation - preliminary results from a single centre experience

European Heart Journal ◽

10.1093/eurheartj/ehz748.0434 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D J Bowen ◽

Y C Yalcin ◽

M Strachinaru ◽

J S McGhie ◽

A E Van Den Bosch ◽

...

Keyword(s):

Heart Failure ◽

Right Ventricle ◽

Right Ventricular ◽

Ventricular Function ◽

Right Ventricular Function ◽

Advanced Heart Failure ◽

Free Wall ◽

Heart Failure Patients ◽

Echocardiographic Evaluation ◽

The Right

Abstract Introduction Right sided heart failure (RVF) is recognized as a major cause of morbidity and mortality after left ventricular assist device (LVAD) implantation. Despite the publication of several risk scores and predication models, identifying patients at risk for RVF after LVAD implantation remains a challenge. The right ventricle is complex in structure and not possible to fully assess from one echocardiographic 2D plane. Our centre previously introduced a novel multi-plane approach whereby four different RV free wall segments (lateral, anterior, inferior and inferior coronal – figure 1) can be imaged from the same echocardiographic position using electronic plane rotation. Purpose The aim of the study was to determine the feasibility of using multi-plane echocardiography to quantify right ventricular function in a small cohort of advanced heart failure patients prior to LVAD implantation. Methods Twelve advanced heart failure patients underwent detailed RV assessment by multi-plane echocardiography prior to LVAD implantation (median -15 [6.3–29.8] days before). Feasibility and values of the established RV functional echo parameters tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler imaging derived tricuspid annular peak systolic velocity (TDI S') were assessed by an experienced sonographer on each of the 4 free wall segments. Mean values were calculated from an average of 3 measurements. Conventional 2D echo parameters and clinical outcome data post LVAD implantation were also collected. Results Feasibility of TAPSE and TDI measurements in all four RV free wall segments was 100%, with the exception of the inferior coronal wall (91.7% – TDI S' only). Mean 4 wall averaged TAPSE was 13.9±5.1mm, whilst mean TDI S' was 9.4±2.6cm/s. Mean TAPSE and TDI values were lower in the inferior and inferior coronal walls (13.3±5.8mm; 8.8±3.1cm/s and 10.9±5.7mm; 8.9±3.7cm/s) than those of the lateral and anterior walls (15.6±5.1mm; 9.9±2.3cm/s and 15.9±5.1mm; 10.1±2.6cm/s). The cohort was split by using a four wall averaged TAPSE value of 16mm as a cutoff. Mean 4 wall averaged TAPSE was 20.6±1.9mm in the >16mm group compared to 10.5±1.7mm for the <16mm group, whilst mean TDI S' was 9.4±2.6cm/s vs 7.7±0.7cm/s. Post LVAD implantation, there were 3 (25%) deaths and 6 (50%) incidences of acute kidney injury. Median length of stay in ICU and hospital was 4 (1–13.5) and 42.5 (30.3–65) days respectively. The <16mm group had higher incidences of negative outcomes and longer stay in both ICU and hospital following LVAD implantation (p: 0.07). Conclusion Multi-plane echocardiographic evaluation of the right ventricle appears feasible in advanced heart failure with potential for a more comprehensive quantification of right ventricular function pre-LVAD implantation. Larger, ideally multi-centre studies are required to further assess these preliminary findings.

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