<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec><h3>Background</h3><p>Advanced heart failure (HF) represents a clinical entity encompassing severely symptomatic HF with severely dysfunctional left ventricles (LV). The single most important parameter for defining severe LV dysfunction and indicating the prescription of evidence-based therapies is LV ejection fraction (EF). We sought to investigate the hemodynamics by echocardiography in a cohort of advanced HF patients during a hospitalization for HF decompensation and assess the relevant differences when compared to a control cohort of asymptomatic patients with minor structural/functional cardiac abnormalities.</p></sec>
<sec><h3>Methods and results</h3><p>In this prospective study we selected 18 advanced HF patients and 12 asymptomatic pre-HF patients with only minor structural/functional abnormalities. The 2 groups were clearly delineated by size parameters (end -systolic and -diastolic diameters and volumes respectively, with very low p values p&lt;0.0001). Hemodynamic parameters were significantly different as well in the advanced HF group vs the ‘pre-HF’ group, including: ventricular-arterial coupling 1.745 vs. 0.895, p=0.0007; cardiac power output 0.762 vs. 0.932, p=0.044, systolic times ratio 0.406 vs. 0.200, p=0.0001. There were no significant differences for neither effective arterial elastance (Ea) and nor for cardiac index. Inside the advanced HF group, no correlation between LVEF and other parameters were found and none of these parameters could predict outcome. We observed a highly skewed variation of Ea in advanced HF patients.</p></sec>
<sec><h3>Conclusion</h3><p>Among the most severe HF patients, the hemodynamic interaction between the dysfunctional LV and the compensatory response of the peripheral system is heterogenous and cannot predict outcome by single parameters. In these patients, assessment of cardiac performance should no longer rely on LEVF alone.</p></sec>
</abstract>

BackgroundAdvanced heart failure (HF) represents a clinical entity encompassing severely symptomatic HF with severely dysfunctional left ventricles (LV). The single most important parameter for defining severe LV dysfunction and indicating the prescription of evidence-based therapies is LV ejection fraction (EF). We sought to investigate the hemodynamics by echocardiography in a cohort of advanced HF patients during a hospitalization for HF decompensation and assess the relevant differences when compared to a control cohort of asymptomatic patients with minor structural/functional cardiac abnormalities.
Methods and resultsIn this prospective study we selected 18 advanced HF patients and 12 asymptomatic pre-HF patients with only minor structural/functional abnormalities. The 2 groups were clearly delineated by size parameters (end -systolic and -diastolic diameters and volumes respectively, with very low p values p<0.0001). Hemodynamic parameters were significantly different as well in the advanced HF group vs the ‘pre-HF’ group, including: ventricular-arterial coupling 1.745 vs. 0.895, p=0.0007; cardiac power output 0.762 vs. 0.932, p=0.044, systolic times ratio 0.406 vs. 0.200, p=0.0001. There were no significant differences for neither effective arterial elastance (Ea) and nor for cardiac index. Inside the advanced HF group, no correlation between LVEF and other parameters were found and none of these parameters could predict outcome. We observed a highly skewed variation of Ea in advanced HF patients.
ConclusionAmong the most severe HF patients, the hemodynamic interaction between the dysfunctional LV and the compensatory response of the peripheral system is heterogenous and cannot predict outcome by single parameters. In these patients, assessment of cardiac performance should no longer rely on LEVF alone.

Echocardiographic Hemodynamic Heterogeneity of Advanced Heart Failure Patients as Compared to Patients with „Pre-Heart Failure”

„Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases

„Carol Davila” University of Medicine and Pharmacy

Romanian Journal of Cardiology

This work is licensed under the Creative Commons Attribution 4.0 International License.

BackgroundAdvanced heart failure (HF) represents a clinical entity encompassing severely symptomatic HF with severely dysfunctional left ventricles (LV). The...

Echocardiographic Hemodynamic Heterogeneity of Advanced Heart Failure Patients as Compared to Patients with „Pre-Heart Failure”

Article Category: Original Article

Publié en ligne: 03 mai 2022

Pages: 351 - 359

DOI: https://doi.org/10.47803/rjc.2021.31.2.351

Mots clés
echocardiography, hemodynamic heterogeneity, heart failure, patients

© 2021 Elena-Laura Antohi et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Echocardiographic Hemodynamic Heterogeneity of Advanced Heart Failure Patients as Compared to Patients with „Pre-Heart Failure”

Article Category: Original Article

Publié en ligne: 03 mai 2022

Pages: 351 - 359

DOI: https://doi.org/10.47803/rjc.2021.31.2.351

Mots clésechocardiography, hemodynamic heterogeneity, heart failure, patients

© 2021 Elena-Laura Antohi et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Mots clés
echocardiography, hemodynamic heterogeneity, heart failure, patients