Estimation of the plasma volume status of elderly patients with acute decompensated heart failure using bedside clinical, biological, and ultrasound parameters

Leahova-Cerchez, Xenia; Berthelot, Emmanuelle; Genet, Bastien; Hanon, Olivier; Jourdain, Patrick

doi:10.1002/clc.23791

Cited by 3 publications

(2 citation statements)

References 29 publications

(51 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The main studies [21][22][23][24][25][26] evaluating approach based on volume status for the management of AHF and chronic HF are summarized in Table 2.…”

Section: Acute Heart Failure Management: Is a Change In The Approach ...mentioning

confidence: 99%

“…Leahova-Cerchez et al [21] Integrated approach based on clinical (JVD, HJR), biological and echocardiographic (IVC) signs of congestion may guide diuretic therapy, reducing the risk of renal failure in patients >75 years old with acute decompensated HF Khandwalla et al [24] Increasing IVC diameter, as demonstrated by ultrasound, is associated with increased risk for HF hospitalization and may be useful to manage patients.…”

Section: Acute Heart Failure Main Findings Chronic Heart Failure Main...mentioning

confidence: 99%

See 1 more Smart Citation

Heart Failure Pharmacological Management: Gaps and Current Perspectives

Severino

D’Amato

Prosperi

et al. 2023

JCM

View full text Add to dashboard Cite

Proper therapeutic management of patients with heart failure (HF) is a major challenge for cardiologists. Current guidelines indicate to start therapy with angiotensin converting enzyme inhibitors/ angiotensin receptor neprilysin inhibitors (ACEi/ARNI), beta blockers (BB), mineralocorticoid receptor antagonists and sodium glucose cotransporter 2 inhibitors (SGLT2i) to reduce the risk of death and hospitalization due to HF. However, certain aspects still need to be defined. Current guidelines propose therapeutic algorithms based on left ventricular ejection fraction values and clinical presentations. However, these last do not always reflect the precise hemodynamic status of patients and pathophysiologic mechanisms involved, particularly in the acute setting. Even in the field of chronic management there are still some critical points to discuss. The guidelines do not specify which of the four pillar drugs to start first, nor at what dosage. Some authors suggest starting with SGLT2i and BB, others with ACEi or ARNI, while one of the most recent approach proposes to start with all four drugs together at low doses. The aim of this review is to revise current gaps and perspectives regarding pharmacological therapy management in HF patients, in both the acute and chronic phase.

show abstract

“…The main studies [21][22][23][24][25][26] evaluating approach based on volume status for the management of AHF and chronic HF are summarized in Table 2.…”

Section: Acute Heart Failure Management: Is a Change In The Approach ...mentioning

confidence: 99%

Section: Acute Heart Failure Main Findings Chronic Heart Failure Main...mentioning

confidence: 99%

Heart Failure Pharmacological Management: Gaps and Current Perspectives

Severino

D’Amato

Prosperi

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

Estimation of the plasma volume status of elderly patients with acute decompensated heart failure using bedside clinical, biological, and ultrasound parameters

Leahova-Cerchez

Berthelot

Genet

et al. 2022

Clinical Cardiology

View full text Add to dashboard Cite

Objective: Assessment of intravascular volume status to ensure optimization before hospital discharge could significantly reduce readmissions. It is difficult to evaluate congestion on clinical signs during an episode of acute heart failure (ADHF) in elderly patients.Hypothesis: There is an association between various volume overload parameters in patients older than 75 years. Methods:We performed a single-center prospective longitudinal study of patients older than 75 years hospitalized for acute heart failure. We analyzed the association between congestion assessment based on clinical signs, inferior vena cava (IVC) diameter measured by ultrasound, biological evaluation with N terminal pro brain natriuretic peptide (NT-proBNP), and estimated plasma volume (EPV) during decongestive therapy. We also monitored changes in renal function.Results: Fifty consecutive ADHF patients (85.2 ± 5.9 years, 68% female) were included in the study. At admission, a dilated, noncompliant IVC was found in all patients. The strongest correlations between different parameters of volume overload estimation were found between IVC and jugular vein distention (r = .8; p < .001), then IVC and oedema (r = .6; p < .001), IVC and crackles (r = .3; p < .036), then IVC and NT-proBNP (r = .3; p = .02). There was no correlation between EPV and signs of congestion. Patients who had no congestive signs on clinical or IVC examination at Day 2, more often presented with acute renal failure. Conclusion:In ADHF patients older than 75 years, clinical and IVC evaluation of intravascular congestion correlate well. The concomitant assessment of clinical signs and IVC may prevent depletion-related renal failure.

show abstract

Pulmonary Artery Systolic Pressure and Cava Vein Status in Acute Heart Failure with Preserved Ejection Fraction: Clinical and Prognostic Implications

et al. 2023

View full text Add to dashboard Cite

Background: Peak tricuspid regurgitation (TR) velocity and inferior cava vein (ICV) distention are two recognized features of increased pulmonary artery pressure (PASP) and right atrial pressure, respectively. Both parameters are related to pulmonary and systemic congestion and adverse outcomes. However, few data exist about the assessment of PASP and ICV in acute patients affected by heart failure with preserved ejection fraction (HFpEF). Thus, we investigated the relationship existing among clinical and echocardiographic features of congestion, and we analyzed the prognostic impact of PASP and ICV in acute HFpEF patients. Methods and Results: We analyzed clinical congestion PASP and ICV value in consecutive patients admitted in our ward by echocardiographic examination using peak Doppler velocity tricuspid regurgitation and ICV diameter and collapse for the assessment of PASP and ICV dimension, respectively. A total of 173 HFpEF patients were included in the analysis. The median age was 81 and median left ventricular ejection fraction (LVEF) was 55% [50–57]. Mean values of PASP was 45 mmHg [35–55] and mean ICV was 22 [20–24] mm. Patients with adverse events during follow-up showed significantly higher values of PASP (50 [35–55] vs. 40 [35–48] mmHg, (p = 0.005) and increased values of ICV (24 [22–25] vs. 22 [20–23] mm, p < 0.001). Multivariable analysis showed prognostic power of ICV dilatation (HR 3.22 [1.58–6.55], p = 0.001) and clinical congestion score ≥ 2 (HR 2.35 [1.12–4.93], p = 0.023), but PASP increase did not reach statistical significance (p = 0.874). The combination of PASP > 40 mmHg and ICV > 21 mm was capable of identifying patients with increased events (45% vs. 20%). Conclusions: ICV dilatation provides additional prognostic information with respect to PASP in patients with acute HFpEF. A combined model adding PASP and ICV assessment to clinical evaluation is a useful tool for predicting HF related events.

show abstract

Estimation of the plasma volume status of elderly patients with acute decompensated heart failure using bedside clinical, biological, and ultrasound parameters

Cited by 3 publications

References 29 publications

Heart Failure Pharmacological Management: Gaps and Current Perspectives

Heart Failure Pharmacological Management: Gaps and Current Perspectives

Estimation of the plasma volume status of elderly patients with acute decompensated heart failure using bedside clinical, biological, and ultrasound parameters

Pulmonary Artery Systolic Pressure and Cava Vein Status in Acute Heart Failure with Preserved Ejection Fraction: Clinical and Prognostic Implications

Contact Info

Product

Resources

About