C Cogliati1, E Ceriani2, G Gambassi3, G De Matteis4, S Perlini5, T Perrone6, M L Muiesan7, M Salvetti7, F Leidi1, F Ferrara8, C Sabbà9, P Suppressa9, A Fracanzani10, N Montano11, E Fiorelli11, G Tripepi12, M Gori13, A Pitino13, A Pietrangelo8. 1. Department of Biomedical and Clinical Sciences, University of Milan, ASST Fatebenefratelli- Sacco, Italy. 2. Department of Biomedical and Clinical Sciences, University of Milan, ASST Fatebenefratelli- Sacco, Italy. Electronic address: elisa.ceriani@asst-fbf-sacco.it. 3. Department of Medicine and Traslational Surgery, Università Cattolica del Sacro Cuore Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy. 4. Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. 5. Emergency Department, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy. 6. Internal Medicine 1, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy. 7. Department of Clinical and Experimental Sciences, University of Brescia-ASST Spedali Civili Brescia, Brescia, Italy. 8. Department of Internal and Emergency Medicine, University Hospital of Modena, Italy. 9. Division of Internal Medicine and Geriatrics, DIM Department, University of Bari, Italy. 10. Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Italy. 11. Department of Clinical Sciences and Health Community, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Italy. 12. Institute of Clinical Physiology (IFC-CNR), Section of Reggio Calabria, Italy. 13. Institute of Clinical Physiology (IFC-CNR), Section of Rome, Italy.
Abstract
AIMS: To evaluate pulmonary and intravascular congestion at admission and repeatedly during hospitalization for acute decompensated heart failure (ADHF) in HFrEF and HFpEF patients using lung (LUS) and inferior vena cava (IVC) ultrasound. METHODS AND RESULTS: Three-hundred-fourteen patients (82±9 years; HFpEF =172; HFrEF=142) admitted to Internal Medicine wards for ADHF were enrolled in a multi-center prospective study. At admission HFrEF presented higher indexes of pulmonary and intravascular congestion (LUS-score: 0.9 ± 0.4 vs 0.7 ± 0.4; p<0.01; IVC end-expiratory diameter: 21.6 ± 5.1 mm vs 20±5.5 mm, p<0.01; IVC collapsibility index 24.4 ± 17.4% vs 30.9 ± 21.1% p<0.01) and higher Nt-proBNP values (8010 vs 3900 ng/l; p<0.001). At discharge, HFrEF still presented higher B-scores (0.4 ± 4 vs 0.3 ± 0.4; p = 0.023), while intravascular congestion improved to a greater extent, thus IVC measurements were similar in the two groups. No differences in diuretic doses, urine output, hemoconcentration, worsening renal function were found. At 90-days follow up HF readmission/death did not differ in HFpEF and HFrEF (28% vs 31%, p = 0,48). Residual congestion was associated with HF readmission/death considering the whole population; while intravascular congestion predicted readmission/death in the HFrEF, no association between sonographic indexes and the outcome was found in HFpEF. CONCLUSIONS: Serial assessment of pulmonary and intravascular congestion revealed a higher burden of fluid overload in HFrEF and, conversely, a greater reduction in intravascular venous congestion with diuretic treatment. Although other factors beyond EF could play a role in congestion/decongestion patterns, our data may be relevant for further phenotyping HF patients, considering the importance of decongestion optimization in the clinical approach.
AIMS: To evaluate pulmonary and intravascular congestion at admission and repeatedly during hospitalization for acute decompensated heart failure (ADHF) in HFrEF and HFpEF patients using lung (LUS) and inferior vena cava (IVC) ultrasound. METHODS AND RESULTS: Three-hundred-fourteen patients (82±9 years; HFpEF =172; HFrEF=142) admitted to Internal Medicine wards for ADHF were enrolled in a multi-center prospective study. At admission HFrEF presented higher indexes of pulmonary and intravascular congestion (LUS-score: 0.9 ± 0.4 vs 0.7 ± 0.4; p<0.01; IVC end-expiratory diameter: 21.6 ± 5.1 mm vs 20±5.5 mm, p<0.01; IVC collapsibility index 24.4 ± 17.4% vs 30.9 ± 21.1% p<0.01) and higher Nt-proBNP values (8010 vs 3900 ng/l; p<0.001). At discharge, HFrEF still presented higher B-scores (0.4 ± 4 vs 0.3 ± 0.4; p = 0.023), while intravascular congestion improved to a greater extent, thus IVC measurements were similar in the two groups. No differences in diuretic doses, urine output, hemoconcentration, worsening renal function were found. At 90-days follow up HF readmission/death did not differ in HFpEF and HFrEF (28% vs 31%, p = 0,48). Residual congestion was associated with HF readmission/death considering the whole population; while intravascular congestion predicted readmission/death in the HFrEF, no association between sonographic indexes and the outcome was found in HFpEF. CONCLUSIONS: Serial assessment of pulmonary and intravascular congestion revealed a higher burden of fluid overload in HFrEF and, conversely, a greater reduction in intravascular venous congestion with diuretic treatment. Although other factors beyond EF could play a role in congestion/decongestion patterns, our data may be relevant for further phenotyping HF patients, considering the importance of decongestion optimization in the clinical approach.