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Chang HC, Huang CJ, Cheng HM, Yu WC, Chiang CE, Sung SH, Chen CH. Nocturnal thoracic volume overload and post-discharge outcomes in patients hospitalized for acute heart failure. ESC Heart Fail 2020; 7:2807-2817. [PMID: 32681759 PMCID: PMC7524107 DOI: 10.1002/ehf2.12881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 06/05/2020] [Accepted: 06/17/2020] [Indexed: 01/11/2023] Open
Abstract
Aims Volume overload and perturbations of pulsatile haemodynamics may precipitate acute heart failure (AHF). Nocturnal thoracic volume overload due to rostral fluid shift during recumbency undetected by daytime measures may impact nighttime haemodynamics and post‐discharge outcomes. Methods and results A total of 63 patients (median 60 years, 79.4% men, and left ventricular ejection fraction 29.4%) hospitalized for AHF were enrolled. Once clinical euvolaemia was achieved, noninvasive pulsatile haemodynamics were assessed during daytime followed by circadian monitoring (6 p.m. to 5 a.m.) of thoracic fluid content and thoracic fluid content index (TFCi) using impedance cardiography, normalized electromechanical activation time ratio (EMAT%) using acoustic cardiography, and mean blood pressure using ambulatory blood pressure monitoring before discharge. The primary endpoints were composited of the first hospitalization for heart failure and death from any cause. Patients were also followed for the repeated heart failure hospitalizations. During a median follow‐up duration of 16 months, 33 patients encountered primary composite endpoints (52.4%), and there were 42 hospitalizations developed among 25 patients. An overnight increase in TFCi along with persistently prolonged EMAT% and low mean blood pressure was observed in the eventful group. Overnight increase in TFCi (ΔTFCi, the difference between the measures at 4 a.m. and 6 p.m.) was an independent predictor of primary composite events (hazard ratio and 95% confidence interval: 1.58, 1.07–2.33; P = 0.022) and recurrent composite events (2.22, 1.51–3.26; P < 0.001), after adjusting for potential confounding factors. A high ΔTFCi (≥0.5/kΩ/m2) significantly correlated with higher post‐discharge events (hazard ratio 6.25; 95% confidence interval 2.30–16.96; P < 0.001) in comparison with a low ΔTFCi (<0.5/kΩ/m2). ΔTFCi was significantly associated with EMAT%, estimated glomerular filtration rate, and left ventricular ejection fraction, but not with parameters of pulsatile haemodynamics. Conclusions Nocturnal thoracic volume overload in AHF before discharge, indicating the presence of residual volume overload unidentified by daytime measures, may predict post‐discharge outcomes.
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Affiliation(s)
- Hao-Chih Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Chi-Jung Huang
- Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hao-Min Cheng
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Chung Yu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Chern-En Chiang
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Hsien Sung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chen-Huan Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Haemodynamic Effects of Anaemia in Patients with Acute Decompensated Heart Failure. Cardiol Res Pract 2020; 2020:9371967. [PMID: 32274212 PMCID: PMC7115042 DOI: 10.1155/2020/9371967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/24/2020] [Indexed: 12/28/2022] Open
Abstract
Anaemia is a common comorbidity in patients with heart failure (HF) and is associated with more severe symptoms and increased mortality. The aim of this study was to evaluate haemodynamic profiles of HF patients with respect to the presence of reduced left ventricular ejection fraction (LVEF) and anaemia. Methods and Results. Haemodynamic status was evaluated in 97 patients with acute decompensated HF. Impedance cardiography, echocardiography, and N-terminal probrain natriuretic peptide (NT-proBNP) results were analysed. The study group was stratified into four subgroups according to LVEF (<40% vs ≥40%) and the presence of anaemia (haemoglobin <13.0 g/dL in men and <12.0 g/dL in women). Thoracic fluid content was higher (p=0.037) in anaemic subjects, while no significant relation between anaemia and NYHA was observed. Anaemic subjects with LVEF ≥ 40% were distinguished from those with LVEF < 40% by significantly higher stroke index (p=0.002), Heather index (p=0.014), and acceleration index (p=0.047). Patients with reduced LVEF and anaemia presented the highest NT-proBNP (p=0.003). Conclusions. In acute decompensated HF, anaemia is related with fluid overload, relatively higher cardiac systolic performance but no clinical benefit in patients with preserved/midrange LVEF, and increased left ventricular tension, fluid overload, and impaired cardiac systolic performance in patients with reduced LVEF.
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