Lucas N L Van Aelst1,2,3, Mattia Arrigo3,4,5, Rui Placido3,6, Eiichi Akiyama3,7, Nicolas Girerd8, Faiez Zannad8, Philippe Manivet3,9,10, Patrick Rossignol8, Marc Badoz11, Malha Sadoune3, Jean-Marie Launay3,9,10, Etienne Gayat3,5,12, Carolyn S P Lam13, Alain Cohen-Solal2,3,12, Alexandre Mebazaa3,5,12, Marie-France Seronde3,11. 1. Department of Cardiovascular Sciences KU Leuven, Campus Gasthuisberg O&N1, Leuven, Belgium. 2. Department of Cardiology, Hôpital Lariboisière, Paris, France. 3. U942 INSERM, Assistance Publique - Hôpitaux de Paris, Paris, France. 4. Division of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland. 5. Department of Anesthesia and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisière, Paris, France. 6. Hospital Santa Maria, Serv Cardiologia I, Lisbon Academic Medical Centre, CCUL, Lisbon, Portugal. 7. Division of Cardiology, Yokohama City University Medical Center, Minamiku, Yokohama, Japan. 8. INSERM, Centre d'Investigations Cliniques Plurithématique, CHRU de Nancy, Université de Lorraine, CHRU de Nancy, and F-CRIN INI-CRCT, Nancy, France. 9. Department of Medical Biochemistry and Molecular Biology, Hôpital Lariboisière, Paris, France. 10. Biossip Analytical Platform, Center for Biological Resources, Lariboisière Hospital, Paris, France. 11. Department of Cardiology, University Hospital Jean Minjoz, Besançon, France. 12. University Paris Diderot, Sorbonne Paris Cité, Paris, France. 13. National Heart Centre Singapore and Duke-National University of Singapore, Singapore.
Abstract
AIMS: Congestion is a central feature of acute heart failure (HF) and its assessment is important for clinical decisions (e.g. tailoring decongestive treatments). It remains uncertain whether patients with acute HF with preserved ejection fraction (HFpEF) are comparably congested as in acute HF with reduced EF (HFrEF). This study assessed congestion, right ventricular (RV) and renal dysfunction in acute HFpEF, HFrEF and non-cardiac dyspnoea. METHODS AND RESULTS: We compared echocardiographic and circulating biomarkers of congestion in 146 patients from the MEDIA-DHF study: 101 with acute HF (38 HFpEF, 41 HFrEF, 22 HF with mid-range ejection fraction) and 45 with non-cardiac dyspnoea. Compared with non-cardiac dyspnoea, patients with acute HF had larger left and right atria, higher E/e', pulmonary artery systolic pressure and inferior vena cava (IVC) diameter at rest, and lower IVC variability (all P < 0.05). Mid-regional pro-atrial natriuretic peptide (MR-proANP) and soluble CD146 (sCD146), but not B-type natriuretic peptide (BNP), correlated with echocardiographic markers of venous congestion. Despite a lower BNP level, patients with HFpEF had similar evidence of venous congestion (enlarged IVC, left and right atria), RV dysfunction (tricuspid annular plane systolic excursion), elevated MR-proANP and sCD146, and renal impairment (estimated glomerular filtration rate; all P > 0.05) compared with HFrEF. CONCLUSION: In acute conditions, HFpEF and HFrEF presented in a comparable state of venous congestion, with similarly altered RV and kidney function, despite higher BNP in HFrEF.
AIMS: Congestion is a central feature of acute heart failure (HF) and its assessment is important for clinical decisions (e.g. tailoring decongestive treatments). It remains uncertain whether patients with acute HF with preserved ejection fraction (HFpEF) are comparably congested as in acute HF with reduced EF (HFrEF). This study assessed congestion, right ventricular (RV) and renal dysfunction in acute HFpEF, HFrEF and non-cardiac dyspnoea. METHODS AND RESULTS: We compared echocardiographic and circulating biomarkers of congestion in 146 patients from the MEDIA-DHF study: 101 with acute HF (38 HFpEF, 41 HFrEF, 22 HF with mid-range ejection fraction) and 45 with non-cardiac dyspnoea. Compared with non-cardiac dyspnoea, patients with acute HF had larger left and right atria, higher E/e', pulmonary artery systolic pressure and inferior vena cava (IVC) diameter at rest, and lower IVC variability (all P < 0.05). Mid-regional pro-atrial natriuretic peptide (MR-proANP) and soluble CD146 (sCD146), but not B-type natriuretic peptide (BNP), correlated with echocardiographic markers of venous congestion. Despite a lower BNP level, patients with HFpEF had similar evidence of venous congestion (enlarged IVC, left and right atria), RV dysfunction (tricuspid annular plane systolic excursion), elevated MR-proANP and sCD146, and renal impairment (estimated glomerular filtration rate; all P > 0.05) compared with HFrEF. CONCLUSION: In acute conditions, HFpEF and HFrEF presented in a comparable state of venous congestion, with similarly altered RV and kidney function, despite higher BNP in HFrEF.
Authors: Varol Burak Aydemir; Supriya Nagesh; Md Mobashir Hasan Shandhi; Joanna Fan; Liviu Klein; Mozziyar Etemadi; James Alex Heller; Omer T Inan; James M Rehg Journal: IEEE Trans Biomed Eng Date: 2019-08-15 Impact factor: 4.538
Authors: Eva M Boorsma; Jozine M Ter Maaten; Kevin Damman; Wilfried Dinh; Finn Gustafsson; Steven Goldsmith; Daniel Burkhoff; Faiez Zannad; James E Udelson; Adriaan A Voors Journal: Nat Rev Cardiol Date: 2020-05-15 Impact factor: 32.419
Authors: Ovidiu Chioncel; Sean P Collins; Andrew P Ambrosy; Peter S Pang; Elena-Laura Antohi; Vlad Anton Iliescu; Aldo P Maggioni; Javed Butler; Alexandre Mebazaa Journal: Am J Ther Date: 2018 Jul/Aug Impact factor: 2.688