Monitoring stroke volume changes in acute heart failure patients. (25th November 2020)

• Record Type: Journal Article
• Authors: Barki, M; Losito, M; Caracciolo, M.M; Bandera, F; Rovida, M; Alfonzetti, E; Guazzi, M
• Is Part Of: European heart journal. Volume 41:(2020)Supplement 2
• Publication Date: 2020-11-25
• Subjects: Acute Heart Failure: Imaging; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/ehjci/ehaa946.1217
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Stroke volume (SV) is the net result of cardiac dynamics and functional capacity. Notably, acute decompensated heart failure (ADHF) patients admitted highly congested and with a reduced SV (primarily wet and cold phenotype) exhibit a poorer prognosis. However, how SV may change in wet and warm phenotype during acute hospital setting remains undefined. Purpose: To evaluate, in a cohort of ADHF patients, the pattern of SV changes during hospitalization. Methods: Eighty-one ADHF patients (mean age 75.75±10.6 years, 59% males) warm and wet phenotype were prospectively enrolled within 24–48 hours from admission to the emergency department. In either the acute phase and at pre-discharge all patients underwent M-Mode, 2-Dimensions, Doppler and Speckle Tracking echocardiography (STE). SV and SV indexed (SVi) were estimated using the non-invasive doppler method multiplying the left ventricular outflow tract (LVOT) cross-sectional area (CSA) and the velocity time-integral (VTI) of the LVOT. Results: From admission to discharge, despite a targeted decongestion we observed only minimal and non-significant changes in the average SV and SVi (SV: from 46.9±14.7 ml at admission to 47.2±15.12 at discharge, p=0.9; SVi: from 26.6±8.5 ml/m 2 at admission to 27.1±8.4 ml/m 2 at discharge, p=0.73). When we looked at those patients improving (Group I) vs non improving SV (Group II) we observed that subjects in Group I exhibited a significantly lower prevalence of mitral regurgitation (MR) both at admission (Group I: MR adm. 23% vs Group II: MR adm: 53% p<0.05) and at the pre-discharge (Group I: MR disch. 13.4% vs Group II: MR disch. 45% p<0.05), a significantly higher global peak atrial longitudinal strain (GPALS) at pre-discharge (Group I: GPALS disch. 17.25±6.5% vs Group II disch. 11±7.1%; p=0.04), along with a significantly greater improvement in terms of GPALS (ΔGPLAS) during hospitalization (Group I: from 13±6.9% to 17.25±6.5%, p=0.04; Group II: from 13.85±8.4% to 11±7.1%, p=0.6) (Figure 1). Interestingly, when evaluated with Pearson's coefficient, in the whole population a significant direct correlation was observed between ΔSV and ΔGPALS (r=0.67 95% CI 0.4–0.7, p<0.001) (Figure 2). Conclusions: In ADHF patients, the wet and warm phenotype displays a decreased forward SV which does not improve after decongestion therapy on average variations. In this context, the coexistence of LA impairment and hemodynamically significant MR seems to play a key role whereas, LA functional properties recover at least in part in patients who are able to show a SV improvement. Further analysis are necessary to test whether a lack of SV improvement in the short term may impact the long-term outcome. Funding Acknowledgement: Type of funding source: None