Echocardiography in Acute Heart Failure: Current Perspectives

Papadimitriou, L.; Georgiopoulou, Vasiliki V.; Kort, Smadar; Butler, Javed; Καλογερόπουλος, Ανδρέας

doi:10.1016/j.cardfail.2015.08.001

Cited by 27 publications

(32 citation statements)

References 72 publications

(69 reference statements)

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“…6 Two studies using data from comprehensive transthoracic echocardiograms in heart failure patients demonstrated that a dilated, noncollapsible IVC is associated with higher risk of mortality; however, it is well recognized that obtaining comprehensive transthoracic echocardiograms in all patients hospitalized with heart failure is neither cost-effective nor practical. 7 In recent years, multiple studies have emerged demonstrating that noncardiologists can perform focused cardiac ultrasound exams with high reproducibility and accuracy to guide management of patients with ADHF. [8][9][10][11][12][13][14] However, it is unknown whether IVC characteristics from a focused cardiac ultrasound exam performed by a noncardiologist can predict mortality of patients hospitalized with ADHF.…”

Section: Resultsmentioning

confidence: 99%

Admission inferior vena cava measurements are associated with mortality after hospitalization for acute decompensated heart failure

Cubo-Romano

Torres‐Macho

Soni

et al. 2016

Journal of Hospital Medicine

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BACKGROUND Prognostication of patients hospitalized with acute decompensated heart failure (ADHF) is important to patients, providers, and healthcare systems. Few bedside tools exist to prognosticate patients hospitalized with ADHF. OBJECTIVE The objective of this study was to assess the relationship between inferior vena cava (IVC) diameter and postdischarge mortality in patients hospitalized with ADHF. DESIGN Prospective observational study. SETTING A 247‐bed urban teaching hospital in Spain PATIENTS Ninety‐seven patients hospitalized with ADHF. INTERVENTION None. MEASUREMENTS The IVC diameter and collapsibility were measured by a hospitalist at the time of admission and discharge. Primary outcome was 90‐day all‐cause mortality. Secondary outcomes were readmission rates at 90 and 180 days, and 180‐day all‐cause mortality. Patients were followed for 180 days. RESULTS Data from 80 patients were analyzed. From admission to discharge, a significant improvement in IVC maximum (IVCmax) diameter (2.12 vs 1.87 cm; P < 0.001) and IVC collapsibility (25.7% vs 33.1%; P < 0.001) was seen in the total study cohort. During the 90‐day follow‐up period, 11 patients (13.7%) died. An admission IVCmax diameter ≥1.9 cm was associated with a higher mortality rate at 90 days (25.4% vs 3.4%; P = 0.009) and 180 days (29.3% vs 3.4%; P = .003). In a multivariate Cox proportional hazards regression analysis, admission IVCmax diameter was an independent predictor of 90‐day mortality (hazard ratio [HR]: 5.88; 95% confidence interval [CI]: 1.21‐28.10; P = 0.025) and 90‐day readmission (HR: 3.20; 95% CI: 1.24‐8.21; P = 0.016). CONCLUSION In patients hospitalized with acute decompensated heart failure, a dilated IVC by bedside ultrasound at the time of admission is associated with a higher 90‐day mortality after hospitalization. Journal of Hospital Medicine 2016;11:778–784. © 2016 Society of Hospital Medicine

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Section: Resultsmentioning

confidence: 99%

Admission inferior vena cava measurements are associated with mortality after hospitalization for acute decompensated heart failure

Cubo-Romano

Torres‐Macho

Soni

et al. 2016

Journal of Hospital Medicine

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“…The median (IQR) of TAPSE in patients with and without WRF was 12 (11)(12)(13)(14) mm and 16 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22) mm, respectively (P < 0.001). Seventy-three per cent of patients with WRF showed significant RV dysfunction (considering TAPSE < 16 mm and RV S 0 velocity < 10 cm/s), whereas only 45% of patients without WRF had significant RV dysfunction.…”

Section: Prognostic Significance Of Echocardiographic Findingsmentioning

confidence: 97%

Echocardiographic predictors of worsening renal function in acute heart failure: observations from the RASHF registry

et al. 2018

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AimsEchocardiography is known as the most useful diagnostic test in the assessment of patients with heart failure (HF), and the prognostic significance of echocardiographic findings in HF is well known. In this report, we aim to present the prognostic significance of a limited set of echocardiographic parameters obtained within 24 h of admission of patients enrolled in the Rajaie Acute Systolic Heart Failure registry.Methods and resultsA total of 230 patients with the diagnosis of acute systolic HF (left ventricular ejection fraction ≤ 35%) were enrolled into the study. Transthoracic echocardiography was performed for all study population within 24 h of admission. The primary endpoint of the study was the occurrence of worsening renal function (WRF) during the hospitalization course.Acquiring data of transthoracic echocardiography within 24 h of admission was feasible in all study participants. The median (inter‐quartile range) of left ventricular ejection fraction was 20% (15–23%). Severe right ventricular dysfunction was observed in 21.5% of patients. The grade of inferior vena cava collapse and right ventricular systolic dysfunction were associated with WRF. In multivariable analysis, right ventricular systolic dysfunction was among the independent predictors of WRF [β = 0.8, P = 0.01, odds ratio (OR) = 2.4 (1.2–4.9)] and in‐hospital mortality [β = 0.6, P = 0.04, OR = 1.5 (0.5–4.6)].ConclusionsEchocardiographic parameters are useful for baseline assessment and provide additional information besides other clinical variables for prognostication. Right ventricular dysfunction is the most important risk factor in developing WRF and in‐hospital mortality in patients with acute HF.

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“…Of the adjunct monitoring tools, echocardiography (echo) and lung ultrasound (LUS) allow real‐time evaluation of cardiac filling pressures and pulmonary congestion, and these two modalities can be performed sequentially using the same machinery and probe 11, 12, 13, 14. Furthermore, echo can specify the underlying cardiac disease in AHF 4, 5.…”

Section: Introductionmentioning

confidence: 99%

Focused echocardiography and lung ultrasound protocol for guiding treatment in acute heart failure

et al. 2017

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AimsThere is little evidence‐based therapy existing for acute heart failure (AHF), hospitalizations are lengthy and expensive, and optimal monitoring of AHF patients during in‐hospital treatment is poorly defined. We evaluated a rapid cardiothoracic ultrasound (CaTUS) protocol, combining focused echocardiographic evaluation of cardiac filling pressures, that is, medial E/e′ and inferior vena cava index, with lung ultrasound (LUS) for guiding treatment in hospitalized AHF patients.Methods and resultsWe enrolled 20 consecutive patients hospitalized for AHF, whose in‐hospital treatment was guided using the CaTUS protocol according to a pre‐specified treatment protocol targeting resolution of pulmonary congestion on LUS and lowering cardiac filling pressures. Treatment results of these 20 patients were compared with those of a standard care sample of 100 patients, enrolled previously for follow‐up purposes. The standard care sample had CaTUS performed daily for follow‐up and received standard in‐hospital treatment without ultrasound guidance. All CaTUS exams were performed by a single experienced sonographer. The CaTUS‐guided therapy resulted in significantly larger decongestion as defined by reduction in symptoms, cardiac filling pressures, natriuretic peptides, cumulative fluid loss, and resolution of pulmonary congestion (P < 0.05 for all) despite a shorter mean length of hospitalization. Congestion parameters were significantly lower also at discharge (P < 0.05 for all), without any significant difference in these parameters on admission. The treatment arm displayed better survival regarding the combined endpoint of 6 month all‐cause death or AHF re‐hospitalization (log rank P = 0.017). No significant difference in adverse events occurred between the groups.ConclusionsThe CaTUS‐guided therapy for AHF resulted in greater decongestion during shorter hospitalization without increased adverse events in this small pilot study and might be associated with a better post‐discharge prognosis.

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Echocardiography in Acute Heart Failure: Current Perspectives

Cited by 27 publications

References 72 publications

Admission inferior vena cava measurements are associated with mortality after hospitalization for acute decompensated heart failure

Admission inferior vena cava measurements are associated with mortality after hospitalization for acute decompensated heart failure

Echocardiographic predictors of worsening renal function in acute heart failure: observations from the RASHF registry

Focused echocardiography and lung ultrasound protocol for guiding treatment in acute heart failure

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