Xenia Leahova-Cerchez1, Emmanuelle Berthelot2, Bastien Genet3,4, Olivier Hanon1, Patrick Jourdain2. 1. Hôpital Broca, Service de Gérontologie, Assistance Publique-Hôpitaux de Paris and EA 4468, Université de Paris, Paris, France. 2. Department of Cardiology, Université Paris-Saclay, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France. 3. Department of Biostatistics, Université Paris Sud, Le Kremlin-Bicêtre, France. 4. Department of Statistics and Methodology in Biomedical Research, Paris-Saclay University, Gif-sur-Yvette, France.
Abstract
OBJECTIVE: Assessment of intravascular volume status to ensure optimization before hospital discharge could significantly reduce readmissions. It is difficult to evaluate congestion on clinical signs during an episode of acute heart failure (ADHF) in elderly patients. HYPOTHESIS: There is an association between various volume overload parameters in patients older than 75 years. METHODS: We performed a single-center prospective longitudinal study of patients older than 75 years hospitalized for acute heart failure. We analyzed the association between congestion assessment based on clinical signs, inferior vena cava (IVC) diameter measured by ultrasound, biological evaluation with N terminal pro brain natriuretic peptide (NT-proBNP), and estimated plasma volume (EPV) during decongestive therapy. We also monitored changes in renal function. RESULTS: Fifty consecutive ADHF patients (85.2 ± 5.9 years, 68% female) were included in the study. At admission, a dilated, noncompliant IVC was found in all patients. The strongest correlations between different parameters of volume overload estimation were found between IVC and jugular vein distention (r = .8; p < .001), then IVC and oedema (r = .6; p < .001), IVC and crackles (r = .3; p < .036), then IVC and NT-proBNP (r = .3; p = .02). There was no correlation between EPV and signs of congestion. Patients who had no congestive signs on clinical or IVC examination at Day 2, more often presented with acute renal failure. CONCLUSION: In ADHF patients older than 75 years, clinical and IVC evaluation of intravascular congestion correlate well. The concomitant assessment of clinical signs and IVC may prevent depletion-related renal failure.
OBJECTIVE: Assessment of intravascular volume status to ensure optimization before hospital discharge could significantly reduce readmissions. It is difficult to evaluate congestion on clinical signs during an episode of acute heart failure (ADHF) in elderly patients. HYPOTHESIS: There is an association between various volume overload parameters in patients older than 75 years. METHODS: We performed a single-center prospective longitudinal study of patients older than 75 years hospitalized for acute heart failure. We analyzed the association between congestion assessment based on clinical signs, inferior vena cava (IVC) diameter measured by ultrasound, biological evaluation with N terminal pro brain natriuretic peptide (NT-proBNP), and estimated plasma volume (EPV) during decongestive therapy. We also monitored changes in renal function. RESULTS: Fifty consecutive ADHF patients (85.2 ± 5.9 years, 68% female) were included in the study. At admission, a dilated, noncompliant IVC was found in all patients. The strongest correlations between different parameters of volume overload estimation were found between IVC and jugular vein distention (r = .8; p < .001), then IVC and oedema (r = .6; p < .001), IVC and crackles (r = .3; p < .036), then IVC and NT-proBNP (r = .3; p = .02). There was no correlation between EPV and signs of congestion. Patients who had no congestive signs on clinical or IVC examination at Day 2, more often presented with acute renal failure. CONCLUSION: In ADHF patients older than 75 years, clinical and IVC evaluation of intravascular congestion correlate well. The concomitant assessment of clinical signs and IVC may prevent depletion-related renal failure.
Authors: Masatake Kobayashi; Olivier Huttin; Erwan Donal; Kevin Duarte; Arnaud Hubert; Hervé Le Breton; Elena Galli; Maxime Fournet; Philippe Mabo; Frederic Schnell; Christophe Leclercq; Patrick Rossignol; Nicolas Girerd Journal: Clin Res Cardiol Date: 2020-01-31 Impact factor: 5.460
Authors: Bertram Pitt; Willem Remme; Faiez Zannad; James Neaton; Felipe Martinez; Barbara Roniker; Richard Bittman; Steve Hurley; Jay Kleiman; Marjorie Gatlin Journal: N Engl J Med Date: 2003-03-31 Impact factor: 91.245
Authors: Mattia A E Valente; Adriaan A Voors; Kevin Damman; Dirk J Van Veldhuisen; Barrie M Massie; Christopher M O'Connor; Marco Metra; Piotr Ponikowski; John R Teerlink; Gad Cotter; Beth Davison; John G F Cleland; Michael M Givertz; Daniel M Bloomfield; Mona Fiuzat; Howard C Dittrich; Hans L Hillege Journal: Eur Heart J Date: 2014-02-28 Impact factor: 29.983
Authors: Matthieu Biais; Cédric Carrié; François Delaunay; Nicolas Morel; Philippe Revel; Gérard Janvier Journal: Crit Care Date: 2012-05-14 Impact factor: 9.097