1
|
Grigore M, Grigore AM, Ilieșiu AM. Portal Vein Pulsatility: A Valuable Approach for Monitoring Venous Congestion and Prognostic Evaluation in Acute Decompensated Heart Failure. Diagnostics (Basel) 2024; 14:2029. [PMID: 39335708 PMCID: PMC11431269 DOI: 10.3390/diagnostics14182029] [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: 08/05/2024] [Revised: 09/08/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND The severity of systemic congestion is associated with increased portal vein flow pulsatility (PVP). AIM To determine the usefulness of PVP as a marker of decongestion and prognosis in acute decompensated heart failure (ADHF) patients. METHODS 105 patients, 60% of whom were men, were hospitalized with ADHF, and their PVP index (PVPI) was calculated (maximum velocity-minimum velocity/maximum velocity) × 100 on admission and before discharge, along with their EVEREST score, inferior vena cava diameter (IVC), NT-proBNP, serum sodium, and glomerular filtration rate. A PVPI ≥ 50% was defined as a marker of systemic congestion. After treatment with loop diuretics, a decrease in PVPI of >50% before discharge was considered a marker of decongestion The patients were classified into two groups (G): G1-PVPI decrease ≥ 50% (54 patients) and G2-PVPI decrease < 50% (51 patients). RESULTS At discharge, compared to G2, G1 patients had lower mean PVPI (14.2 vs. 38.9; p < 0.001), higher serum Na (138 vs. 132 mmol/L, p = 0.03), and a higher number of patients with a significant (>30%) NT-proBNP decrease (42 vs. 27, p = 0.007). PVPI correlated with IVC (r = 0.55, p < 0.001), NT-proBNP (r = 0.21, p = 0.04), and serum Na (r = -0.202, p = 0.04). A total of 55% of patients had worsening renal failure (G1 63% vs. G2 48%, p = 0.17). After 90 days, G2 patients had higher mortality (27.45% vs. 3.7 p = 0.001) and rehospitalization (49.01% vs. 33.33%, p < 0.001). In multivariate regression analysis, PVPI was an independent predictor of rehospitalization (OR 1.05, 95% CI 1.00-1.10, p = 0.048). CONCLUSIONS Portal vein flow pulsatility, a meaningful marker of persistent subclinical congestion, is related to short-term prognosis in ADHF patients.
Collapse
Affiliation(s)
- Mihai Grigore
- Internal Medicine and Cardiology Department, Carol Davila University of Medicine and Pharmacy, "Prof. Dr. Theodor Burghele" Clinical Hospital, 020021 Bucharest, Romania
| | - Andreea-Maria Grigore
- Carol Davila University of Medicine and Pharmacy, Cardiology Department Colentina Clinical Hospital, 020021 Bucharest, Romania
| | - Adriana-Mihaela Ilieșiu
- Internal Medicine and Cardiology Department, Carol Davila University of Medicine and Pharmacy, "Prof. Dr. Theodor Burghele" Clinical Hospital, 020021 Bucharest, Romania
| |
Collapse
|
2
|
Pérez C, Diaz-Caicedo D, Almanza Hernández DF, Moreno-Araque L, Yepes AF, Carrizosa Gonzalez JA. Critical Care Ultrasound in Shock: A Comprehensive Review of Ultrasound Protocol for Hemodynamic Assessment in the Intensive Care Unit. J Clin Med 2024; 13:5344. [PMID: 39336831 PMCID: PMC11432640 DOI: 10.3390/jcm13185344] [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: 06/16/2024] [Revised: 07/19/2024] [Accepted: 07/26/2024] [Indexed: 09/30/2024] Open
Abstract
Shock is a life-threatening condition that requires prompt recognition and treatment to prevent organ failure. In the intensive care unit, shock is a common presentation, and its management is challenging. Critical care ultrasound has emerged as a reliable and reproducible tool in diagnosing and classifying shock. This comprehensive review proposes an ultrasound-based protocol for the hemodynamic assessment of shock to guide its management in the ICU. The protocol classifies shock as either low or high cardiac index and differentiates obstructive, hypovolemic, cardiogenic, and distributive etiologies. In distributive shock, the protocol proposes a hemodynamic-based approach that considers the presence of dynamic obstruction, fluid responsiveness, fluid tolerance, and ventriculo-arterial coupling. The protocol gives value to quantitative measures based on critical care ultrasound to guide hemodynamic management. Using critical care ultrasound for a comprehensive hemodynamic assessment can help clinicians diagnose the etiology of shock and define the appropriate treatment while monitoring the response. The protocol's use in the ICU can facilitate prompt recognition, diagnosis, and management of shock, ultimately improving patient outcomes.
Collapse
Affiliation(s)
- Camilo Pérez
- Critical and Intensive Care Medicine Department, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá 110111, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111711, Colombia
| | - Diana Diaz-Caicedo
- Critical and Intensive Care Medicine Department, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá 110111, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111711, Colombia
| | - David Fernando Almanza Hernández
- Critical and Intensive Care Medicine Department, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá 110111, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111711, Colombia
| | - Lorena Moreno-Araque
- Critical and Intensive Care Medicine Department, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá 110111, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111711, Colombia
| | - Andrés Felipe Yepes
- Critical and Intensive Care Medicine Department, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá 110111, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111711, Colombia
| | - Jorge Armando Carrizosa Gonzalez
- Critical and Intensive Care Medicine Department, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá 110111, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111711, Colombia
| |
Collapse
|
3
|
Ranasinghe MP, Koh Y, Vogrin S, Nelson CL, Cohen ND, Voskoboinik A, Nanayakkara S, Haikerwal D, Mateevici C, Wharton J, Casey E, Papapostolou S, Costello B. Early Discharge to Clinic-Based Therapy of Patients Presenting With Decompensated Heart Failure (EDICT-HF): Study Protocol for a Multi-Centre Randomised Controlled Trial. Heart Lung Circ 2024; 33:78-85. [PMID: 38158264 DOI: 10.1016/j.hlc.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Acute decompensated heart failure involves a high rate of mortality and complications. Management typically involves a multi-day hospital admission. However, patients often lose part of their function with each successive admission, and are at a high risk for hospital-associated complications such as nosocomial infection. This study aims to determine the safety and efficacy of the management of patients presenting with acute decompensated heart failure to clinic-based therapy vs usual inpatient care using a reproducible management pathway. METHOD An investigator-initiated, prospective, non-inferiority, 1:1 randomised-controlled trial, stratified by left ventricular ejection fraction including 460 patients with a minimum follow-up of 7 days. This is a multi-centre study to be performed in centres across Victoria, Australia. Participants will be patients with either heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF), admitted for acute decompensation of heart failure. INTERVENTION Early discharge to an outpatient-based Heart Failure Rapid Access Clinical Review (RACER) in addition to frequent medical/nursing at-home review for patients admitted with decompensated heart failure. RESULTS The primary endpoint will be a non-inferiority assessment of re-hospitalisation at 30 days. Secondary outcomes include superiority assessment of hospitalisation at 30 days, a composite clinical endpoint of major adverse cardiac and cerebrovascular event (MACCE), hospital re-admission or mortality at 3 months, achievement of guideline-directed medical therapy, patient assessment of symptoms (visual-analogue scale quantified as area under curve and Kansas City Cardiomyopathy Questionnaire-12 [KCCQ-12]), attendance at 3-month outpatient follow-up, number of bed stays/clinics attended, proportion of patients free from congestion, change in serum creatinine level, treatment for electrolyte disturbances, time to transition from intravenous to oral diuretics, and health economics analysis (cost-benefit analysis, cost-utility analysis, incremental cost-effectiveness ratio). CONCLUSIONS The Early Discharge to Clinic-Based Therapy of Patients Presenting with Decompensated Heart Failure (EDICT-HF) trial will help determine whether earlier discharge to out-of-hospital care is non-inferior to the usual practice of inpatient care, in patients with heart failure admitted to hospital for acute decompensation, as an alternative model of care.
Collapse
Affiliation(s)
- Mark P Ranasinghe
- Western Health, Department of Cardiology, Melbourne, Vic, Australia; The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Vic, Australia
| | - Youlin Koh
- Western Health, Department of Cardiology, Melbourne, Vic, Australia
| | - Sara Vogrin
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Vic, Australia
| | - Craig L Nelson
- Western Health, Division of Chronic and Complex Care, Melbourne, Vic, Australia; Western Health, Department of Nephrology, Melbourne, Vic, Australia
| | - Neale D Cohen
- Baker Heart and Diabetes Institute, Diabetes Clinical Research, Melbourne, Vic, Australia
| | - Aleksandr Voskoboinik
- Western Health, Department of Cardiology, Melbourne, Vic, Australia; Heart Centre, The Alfred Hospital, Melbourne, Vic, Australia
| | | | - Deepak Haikerwal
- Western Health, Department of Cardiology, Melbourne, Vic, Australia
| | - Cristina Mateevici
- Western Health, Ambulatory Care Unit, Melbourne, Vic, Australia; Western Health, Department of Infectious Diseases, Melbourne, Vic, Australia
| | - James Wharton
- Western Health, Ambulatory Care Unit, Melbourne, Vic, Australia
| | - Erin Casey
- Western Health, Division of Chronic and Complex Care, Melbourne, Vic, Australia
| | - Stavroula Papapostolou
- Western Health, Department of Cardiology, Melbourne, Vic, Australia; Heart Centre, The Alfred Hospital, Melbourne, Vic, Australia
| | - Ben Costello
- Western Health, Department of Cardiology, Melbourne, Vic, Australia.
| |
Collapse
|
4
|
Zhang D, Li Q, Liu J, Ma L, Ye J, Hu G, Li G. Calculated plasma volume status is associated with poor outcomes in acute ischemic stroke treated with endovascular treatment. Front Neurol 2023; 14:1229331. [PMID: 37576016 PMCID: PMC10415678 DOI: 10.3389/fneur.2023.1229331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023] Open
Abstract
Background and purpose The impact of calculated plasma volume status (PVS) on the prognosis of acute ischemic stroke treated with endovascular treatment (EVT) remains undetermined. This study aimed to investigate the association between PVS and 90 days functional outcomes after EVT. Methods We enrolled patients treated with EVT in the anterior circulation from a prospective registry. The endpoint was a modified Rankin scale score of ≥3 points at 90 days after EVT. We used multivariable logistic regression models to investigate the association between PVS and poor outcomes. We used the restricted cubic spline to present the linearity between PVS and poor outcomes. Results Among the 187 enrolled patients (median age, 65 years; 35.8% women), a total of 81 patients (43.3%) experienced poor outcomes at 90 days. In multivariable analyses, PVS was associated with poor outcomes despite increasing confounding factors (odds ratio, 3.157; 95% confidence interval, 1.942-5.534; P < 0.001). The restricted cubic spline revealed a positive correlation between PVS and the risk of poor outcomes after EVT (P for nonlinearity = 0.021). Conclusion Our study found that an elevated PVS value was associated with poor outcomes after EVT. Further prospective cohorts were warranted to evaluate the utility of PVS in AIS treated with EVT.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Guangzong Li
- Department of Neurology, The Sixth People's Hospital of Chengdu, Chengdu, China
| |
Collapse
|
5
|
Eke C, Szabó A, Nagy Á, Szécsi B, Szentgróti R, Dénes A, Kertai MD, Fazekas L, Kovács A, Lakatos B, Hartyánszky I, Benke K, Merkely B, Székely A. Association between Hepatic Venous Congestion and Adverse Outcomes after Cardiac Surgery. Diagnostics (Basel) 2022; 12:diagnostics12123175. [PMID: 36553182 PMCID: PMC9777079 DOI: 10.3390/diagnostics12123175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/03/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Hepatic venous flow patterns reflect pressure changes in the right ventricle and are also markers of systemic venous congestion. Fluid management is crucial in patients undergoing cardiac surgery. METHODS Our goal was to determine which factors are associated with the increased congestion of the liver as measured by Doppler ultrasound in patients undergoing cardiac surgery. This prospective, observational study included 41 patients without preexisting liver disease who underwent cardiac surgery between 1 January 2021 and 30 September 2021 at a tertiary heart center. In addition to routine echocardiographic examination, we recorded the maximal velocity and velocity time integral (VTI) of the standard four waves seen in the common hepatic vein (flow profile) using Doppler ultrasound preoperatively and at the 20-24th hour of the postoperative period. The ratios of the retrograde and anterograde hepatic venous waves were calculated, and the waveforms were compared to the baseline value and expressed as a delta ratio. Demographic data, pre- and postoperative echocardiographic parameters, intraoperative variables (procedure, cardiopulmonary bypass time), postoperative factors (fluid balance, vasoactive medication requirement, ventilation time and parameters) and perioperative laboratory parameters (liver and kidney function tests, albumin) were used in the analysis. RESULTS Of the 41 patients, 20 (48.7%) were males, and the median age of the patients was 65.9 years (IQR: 59.8-69.9 years). Retrograde VTI growth showed a correlation with positive fluid balance (0.89 (95% CI 0.785-0.995) c-index. After comparing the postoperative echocardiographic parameters of the two subgroups, right ventricular and atrial diameters were significantly greater in the "retrograde VTI growth" group. The ejection fraction and decrement in ejection fraction to preoperative parameters were significantly different between the two groups. (p = 0.001 and 0.003). Ventilation times were longer in the retrograde VTI group. The postoperative vs. baseline delta VTI ratio of the hepatic vein correlated with positive fluid balance, maximum central venous pressure, and ejection fraction. (B = -0.099, 95% CI = -0.022-0.002, p = 0.022, B = 0.011, 95% CI = 0.001-0.021, p = 0.022, B = 0.091, 95% CI = 0.052-0.213, p = 0.002, respectively.) Conclusion: The increase of the retrograde hepatic flow during the first 24 h following cardiac surgery was associated with positive fluid balance and the decrease of the right ventricular function. Measurement of venous congestion or venous abdominal insufficiency seems to be a useful tool in guiding fluid therapy and hemodynamic management.
Collapse
Affiliation(s)
- Csaba Eke
- Rácz Károly School of PhD Studies, Semmelweis University, Ulloi Ut 26, 1085 Budapest, Hungary
| | - András Szabó
- Rácz Károly School of PhD Studies, Semmelweis University, Ulloi Ut 26, 1085 Budapest, Hungary
| | - Ádám Nagy
- Rácz Károly School of PhD Studies, Semmelweis University, Ulloi Ut 26, 1085 Budapest, Hungary
| | - Balázs Szécsi
- Rácz Károly School of PhD Studies, Semmelweis University, Ulloi Ut 26, 1085 Budapest, Hungary
| | - Rita Szentgróti
- Rácz Károly School of PhD Studies, Semmelweis University, Ulloi Ut 26, 1085 Budapest, Hungary
| | - András Dénes
- Faculty of Medicine, Semmelweis University, Ulloi Ut 26, 1085 Budapest, Hungary
| | - Miklós D. Kertai
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Levente Fazekas
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, 1123 Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, 1123 Budapest, Hungary
| | - Bálint Lakatos
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, 1123 Budapest, Hungary
| | - István Hartyánszky
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, 1123 Budapest, Hungary
| | - Kálmán Benke
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, 1123 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, 1123 Budapest, Hungary
| | - Andrea Székely
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, 1123 Budapest, Hungary
- Faculty of Health Sciences, Semmelweis University, Vas Utca 17, 1088 Budapest, Hungary
- Correspondence:
| |
Collapse
|
6
|
Yokouchi G, Horio T, Matsumoto N, Fukuda K, Yoshimura R, Fujiwara R, Matsuoka Y, Sakamoto Y, Iwashima Y, Oshiro Y, Fujimoto K, Kasayuki N. Renoprotective effect of chronic treatment with sodium-glucose cotransporter 2 inhibitors and its associated factors in Japanese patients with chronic heart failure and diabetes. IJC HEART & VASCULATURE 2022; 43:101152. [DOI: 10.1016/j.ijcha.2022.101152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/12/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022]
|