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Gavelli F, Castello LM, Monnet X, Azzolina D, Nerici I, Priora S, Via VG, Bertoli M, Foieni C, Beltrame M, Bellan M, Sainaghi PP, De Vita N, Patrucco F, Teboul JL, Avanzi GC. Decrease of haemoconcentration reliably detects hydrostatic pulmonary oedema in dyspnoeic patients in the emergency department - a machine learning approach. Int J Emerg Med 2024; 17:114. [PMID: 39237860 PMCID: PMC11375861 DOI: 10.1186/s12245-024-00698-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 08/26/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Haemoglobin variation (ΔHb) induced by fluid transfer through the intestitium has been proposed as a useful tool for detecting hydrostatic pulmonary oedema (HPO). However, its use in the emergency department (ED) setting still needs to be determined. METHODS In this observational retrospective monocentric study, ED patients admitted for acute dyspnoea were enrolled. Hb values were recorded both at ED presentation (T0) and after 4 to 8 h (T1). ΔHb between T1 and T0 (ΔHbT1-T0) was calculated as absolute and relative value. Two investigators, unaware of Hb values, defined the cause of dyspnoea as HPO and non-HPO. ΔHbT1-T0 ability to detect HPO was evaluated. A machine learning approach was used to develop a predictive tool for HPO, by considering the ability of ΔHb as covariate, together with baseline patient characteristics. RESULTS Seven-hundred-and-six dyspnoeic patients (203 HPO and 503 non-HPO) were enrolled over 19 months. Hb levels were significantly different between HPO and non-HPO patients both at T0 and T1 (p < 0.001). ΔHbT1-T0 were more pronounced in HPO than non-HPO patients, both as relative (-8.2 [-11.2 to -5.6] vs. 0.6 [-2.1 to 3.3] %) and absolute (-1.0 [-1.4 to -0.8] vs. 0.1 [-0.3 to 0.4] g/dL) values (p < 0.001). A relative ΔHbT1-T0 of -5% detected HPO with an area under the receiver operating characteristic curve (AUROC) of 0.901 [0.896-0.906]. Among the considered models, Gradient Boosting Machine showed excellent predictive ability in identifying HPO patients and was used to create a web-based application. ΔHbT1-T0 was confirmed as the most important covariate for HPO prediction. CONCLUSIONS ΔHbT1-T0 in patients admitted for acute dyspnoea reliably identifies HPO in the ED setting. The machine learning predictive tool may represent a performing and clinically handy tool for confirming HPO.
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Affiliation(s)
- Francesco Gavelli
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy.
- Emergency Medicine Department, AOU Maggiore della Carità di Novara, C.so Mazzini 18, Novara, 28100, Italy.
- Service de médecine intensive-réanimation, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Hôpitaux universitaires Paris- Saclay, APHP, rue du Général Leclerc, Paris, France.
| | - Luigi Mario Castello
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
- Emergency Medicine Department, AOU Maggiore della Carità di Novara, C.so Mazzini 18, Novara, 28100, Italy
| | - Xavier Monnet
- Service de médecine intensive-réanimation, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Hôpitaux universitaires Paris- Saclay, APHP, rue du Général Leclerc, Paris, France
| | - Danila Azzolina
- Department of Environmental and Preventive Science, University of Ferrara, Ferrara, Italy
| | - Ilaria Nerici
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
- Emergency Medicine Department, AOU Maggiore della Carità di Novara, C.so Mazzini 18, Novara, 28100, Italy
| | - Simona Priora
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
- Emergency Medicine Department, AOU Maggiore della Carità di Novara, C.so Mazzini 18, Novara, 28100, Italy
| | - Valentina Giai Via
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
- Emergency Medicine Department, AOU Maggiore della Carità di Novara, C.so Mazzini 18, Novara, 28100, Italy
| | - Matteo Bertoli
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
- Emergency Medicine Department, AOU Maggiore della Carità di Novara, C.so Mazzini 18, Novara, 28100, Italy
| | - Claudia Foieni
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
- Emergency Medicine Department, AOU Maggiore della Carità di Novara, C.so Mazzini 18, Novara, 28100, Italy
| | - Michela Beltrame
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
- Emergency Medicine Department, AOU Maggiore della Carità di Novara, C.so Mazzini 18, Novara, 28100, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
| | - Nello De Vita
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
| | - Filippo Patrucco
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
| | - Jean-Louis Teboul
- Service de médecine intensive-réanimation, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Hôpitaux universitaires Paris- Saclay, APHP, rue du Général Leclerc, Paris, France
| | - Gian Carlo Avanzi
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
- Emergency Medicine Department, AOU Maggiore della Carità di Novara, C.so Mazzini 18, Novara, 28100, Italy
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Alevroudis I, Kotoulas SC, Tzikas S, Vassilikos V. Congestion in Heart Failure: From the Secret of a Mummy to Today's Novel Diagnostic and Therapeutic Approaches: A Comprehensive Review. J Clin Med 2023; 13:12. [PMID: 38202020 PMCID: PMC10779505 DOI: 10.3390/jcm13010012] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/04/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
This review paper presents a review of the evolution of this disease throughout the centuries, describes and summarizes the pathophysiologic mechanisms, briefly discusses the mechanism of action of diuretics, presents their role in decongesting heart failure in patients, and reveals the data behind ultrafiltration in the management of acutely or chronically decompensated heart failure (ADHF), focusing on all the available data and advancements in this field. Acutely decompensated heart failure (ADHF) presents a critical clinical condition characterized by worsening symptoms and signs of heart failure, necessitating prompt intervention to alleviate congestion and improve cardiac function. Diuretics have traditionally been the mainstay for managing fluid overload in ADHF. Mounting evidence suggests that due to numerous causes, such as coexisting renal failure or chronic use of loop diuretics, an increasing rate of diuretic resistance is noticed and needs to be addressed. There has been a series of trials that combined diuretics of different categories without the expected results. Emerging evidence suggests that ultrafiltration may offer an alternative or adjunctive approach.
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Affiliation(s)
- Ioannis Alevroudis
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (V.V.)
- Intensive Care Medicine Clinic, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | | | - Stergios Tzikas
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (V.V.)
| | - Vassilios Vassilikos
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (V.V.)
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Yadollahi Farsani A, Vakhshoori M, Mansouri A, Heidarpour M, Nikouei F, Garakyaraghi M, Sarrafzadegan N, Shafie D. Relation between Hemoconcentration Status and Readmission Plus Mortality Rate Among Iranian Individuals with Decompensated Heart Failure. Int J Prev Med 2020; 11:163. [PMID: 33312472 PMCID: PMC7716610 DOI: 10.4103/ijpvm.ijpvm_45_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/25/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Hemoconcentration (HC) has been suggested to be a useful biomarker for determination of optimum diuretic therapy in acute heart failure (HF), but role of this factor in rehospitalization and death was still controversial. In this study, we aimed to define relation between HC and readmission and mortality rate among Iranian patients with acute HF. METHODS This was a prospective cohort study done from March 2017 to March 2018 using data of a HF section of Persian Registry Of cardioVascular diseasE. From a total number of 390 registered HF individuals aged 18 years or older, 69 ones showed alterations in hemoglobin (Hb) levels. Hb levels were measured at admission and discharge time. HC was defined as any increased level in Hb during hospitalization. The relation of HC with readmission and death rate was done using multiple logistic regression and Cox proportional hazard model, respectively. RESULTS The mean age of study population was 70.5 ± 11.9 years with the dominant percentage of male participants (66.9%). Patients showing HC during admission did not reveal any significant decreased likelihood of rehospitalization compared to negative ones. In comparison to HC negative patients, those showing increments in Hb levels had a borderline significant lower likelihood of mortality (hazard ratio: 0.82, 95% confidence interval, CI = 0.07-1.18, P = 0.08). CONCLUSIONS Our data suggested that HC was associated marginally with reduced mortality rate 6 months post HF attack and could be utilized as a useful biomarker for risk stratification of HF patients. Several prospective longitudinal population-based studies are necessary proving these associations.
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Affiliation(s)
| | - Mehrbod Vakhshoori
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Asieh Mansouri
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Heidarpour
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farnoosh Nikouei
- Heart Failure Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Garakyaraghi
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Shafie
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Llauger L, Jacob J, Herrero-Puente P, Aguirre A, Suñén-Cuquerella G, Corominas-Lasalle G, Llorens P, Martín-Sánchez FJ, Gil V, Roset A, Ruibal JC, Pérez-Durá MJ, Juan-Gómez MÁ, Garrido JM, Richard F, Lucas-Imbernon FJ, Alonso H, Tost J, Gil C, Miró Ò. The CRAS-EAHFE study: Characteristics and prognosis of acute heart failure episodes with cardiorenal-anaemia syndrome at the emergency department. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:406-418. [PMID: 32403935 DOI: 10.1177/2048872620921602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The coexistence of other comorbidities confers poor outcomes in patients with acute heart failure. Our aim was to determine the characteristics of patients with acute heart failure and cardiorenal anaemia syndrome and the relationship between renal dysfunction and anaemia, alone or combined as cardiorenal anaemia syndrome, on short-term outcomes. METHODS We analysed the Epidemiology of Acute Heart Failure in Emergency Departments registry (cohort of patients with acute heart failure in Spanish emergency departments). Renal dysfunction was defined by an estimated glomerular filtration rate <60 ml/min/m2, anaemia by haemoglobin values <12/<13 g/dl in women/men, and cardiorenal anaemia syndrome as the presence of both. Comparisons were made according to cardiorenal-anaemia syndrome positive (CRAS+) with respect to the rest of patients (CRAS-) and according the presence of renal dysfunction (RD+) and anaemia (A+), (alone, RD+/A-, RD-/A+) or in combination (RD+/A+; i.e. CRAS+) with respect to patients without renal dysfunction and anaemia (RD-/A-). The primary outcome was 30-day mortality, and the secondary outcomes were need for admission, prolonged hospitalisation (>10 days), in-hospital mortality during the index event, and reconsultation and the combination of 30-day post-discharge reconsultation/death. These short-term outcomes were compared and adjusted for differences among groups. RESULTS Of the 13,307 patients analysed, CRAS+ (36.4%) was associated with older age, multiple comorbidities, chronic use of loop diuretics, oedemas and hypotension. The 30-day mortality in CRAS+ was greater than in CRAS- (hazard ratio = 1.46, 95% confidence interval = 1.26-1.68) and RD-/A- (hazard ratio = 1.83, 95% confidence interval = 1.46-2.28) control groups. The mortality level was also higher in RD+/A- (hazard ratio = 1.40, 95% confidence interval = 1.10-1.78) and higher, but not statistically significant, in RD-/A+ (hazard ratio = 1.28, 95% confidence interval = 0.99-1.63) with respect to RD-/A-. All of the secondary outcomes, when related to CRAS- and RD-/A- control groups, were worse for CRAS+ and to a lesser extent, RD+/A-, being more rarely observed in RD-/A+. CONCLUSIONS Cardiorenal anaemia syndrome in acute heart failure is related to greater mortality and worse short-term outcomes, and the impact of renal dysfunction and anaemia seems to be additive.
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Affiliation(s)
- Lluis Llauger
- Emergency Department, Hospital Universitari de Vic, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, Spain
| | | | | | | | | | - Pere Llorens
- Emergency Department, Hospital General de Alicante, Spain
| | - Francisco J Martín-Sánchez
- Emergency Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, University of Barcelona, Spain
| | - Alex Roset
- Emergency Department, Hospital Universitari de Bellvitge, Spain
| | - José C Ruibal
- Emergency Department, Hospital Universitari de Bellvitge, Spain
| | | | | | - José M Garrido
- Emergency Department, Hospital Virgen de la Macarena, Spain
| | | | | | - Héctor Alonso
- Emergency Department, Hospital Marqués de Valdecilla, Spain
| | - Josep Tost
- Emergency Department, Consorci Hospitalari de Terrassa, Spain
| | - Cristina Gil
- Emergency Department, Hospital Universitario de Salamanca, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clínic, University of Barcelona, Spain
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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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