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Journal Articles ESC Heart Failure Year : 2020

Improved cardiac and venous pressures during hospital stay in patients with acute heart failure: an echocardiography and biomarkers study

Eiichi Akiyama (1, 2) , Raphaël Cinotti (3, 2) , Kamilė Čerlinskaitė (4, 2) , Lucas N L van Aelst (5, 2, 6) , Mattia Arrigo (7, 2, 8) , Rui Placido (9) , Tahar Chouihed (10, 11, 12, 2) , Nicolas Girerd (10, 13, 14, 15) , Faiez Zannad (10, 13, 14, 15) , Patrick Rossignol (10, 13, 14, 15) , Marc Badoz (16) , Jean-Marie Launay (17, 18, 2) , Etienne Gayat (14, 2, 8, 19) , Alain Cohen-Solal (20, 2, 19) , Carolyn S P Lam (21, 22, 23) , Jeffrey Testani (24) , Wilfried Mullens (25, 26) , Gad Cotter (27) , Marie-France Seronde (16, 2) , Alexandre Mebazaa (28, 14, 2, 19)
1 Division of Cardiology, Yokohama City University Medical Center
2 MASCOT (UMR_S_942 / U942) - Marqueurs cardiovasculaires en situation de stress
3 CHU Nantes - Centre Hospitalier Universitaire de Nantes
4 Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University
5 KU Leuven - Catholic University of Leuven = Katholieke Universiteit Leuven
6 Service de cardiologie (APHP-Hôpital Lariboisière)
7 University hospital of Zurich [Zurich]
8 Département d’Anesthésie-Réanimation-SMUR [Hôpital Lariboisière]
9 Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, and Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina
10 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
11 UFR de Médicine, Sorbonne Paris Cité, Paris Diderot University, Paris
12 Service d’Accueil des urgences [CHRU Nancy]
13 CIC-P - Centre d'investigation clinique plurithématique Pierre Drouin [Nancy]
14 INI-CRCT - Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy]
15 Cardiovascular & Renal Clinical Trialists - CRCT - French-Clinical Research Infrastructure Network - F-CRIN [Paris]
16 Department of Cardiology, University Hospital Jean Minjoz
17 Department of Medical Biochemistry and Molecular Biology, Hôpital Lariboisière
18 Center for Biological Resources BB-033-00064, Hôpital Lariboisière
19 USPC - Université Sorbonne Paris Cité
20 Department of Cardiology, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique des Hopitaux de Paris
21 NHCS - National Heart Centre Singapore
22 Duke-National University of Singapore Graduate Medical School
23 UMCG - University Medical Center Groningen [Groningen]
24 YSM - Yale School of Medicine [New Haven, Connecticut]
25 Department of Cardiology, Ziekenhuis Oost-Limburg, Genk
26 UHasselt - Hasselt University
27 Momentum Research Inc., Durham
28 Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisiere, Assistance Publique des Hopitaux de Paris

Abstract

Aims: Changes in echocardiographic parameters and biomarkers of cardiac and venous pressures or estimated plasma volume during hospitalization associated with decongestive treatments in acute heart failure (AHF) patients with either preserved left ventricular ejection fraction (LVEF) (HFPEF) or reduced LVEF (HFREF) are poorly assessed. Methods and results: From the metabolic road to diastolic heart failure: diastolic heart failure (MEDIA-DHF) study, 111 patients were included in this substudy: 77 AHF (43 HFPEF and 34 HFREF) and 34 non-cardiac dyspnea patients. Echocardiographic measurements and blood samples were obtained within 4 h of presentation at the emergency department and before hospital discharge. In AHF patients, echocardiographic indices of cardiac and venous pressures, including inferior vena cava diameter [from 22 (16-24) mm to 13 (11-18) mm, P = 0.009], its respiratory variability [from 32 (8-44) % to 43 (29-70) %, P = 0.04], medial E/e' [from 21.1 (15.8-29.6) to 16.6 (11.7-24.3), P = 0.004], and E wave deceleration time [from 129 (105-156) ms to 166 (128-203) ms, P = 0.003], improved during hospitalization, similarly in HFPEF and HFREF patients. By contrast, no changes were seen in non-cardiac dyspnea patients. In AHF patients, all plasma biomarkers of cardiac and venous pressures, namely B-type natriuretic peptide [from 935 (514-2037) pg/mL to 308 (183-609) pg/mL, P < 0.001], mid-regional pro-atrial natriuretic peptide [from 449 (274-653) pmol/L to 366 (242-549) pmol/L, P < 0.001], and soluble CD-146 levels [from 528 (406-654) ng/mL to 450 (374-529) ng/mL, P = 0.003], significantly decreased during hospitalization, similarly in HFPEF and HFREF patients. Echocardiographic parameters of cardiac chamber dimensions [left ventricular end-diastolic volume: from 120 (76-140) mL to 118 (95-176) mL, P = 0.23] and cardiac index [from 2.1 (1.6-2.6) mL/min/m2 to 1.9 (1.4-2.4) mL/min/m2 , P = 0.55] were unchanged in AHF patients, except tricuspid annular plane systolic excursion (TAPSE) that improved during hospitalization [from 16 (15-19) mm to 19 (17-21) mm, P = 0.04]. Estimated plasma volume increased in both AHF [from 4.8 (4.2-5.6) to 5.1 (4.4-5.8), P = 0.03] and non-cardiac dyspnea patients (P = 0.01). Serum creatinine [from 1.18 (0.90-1.53) to 1.19 (0.86-1.70) mg/dL, P = 0.89] and creatinine-based estimated glomerular filtration rate [from 59 (40-75) mL/min/1.73m2 to 56 (38-73) mL/min/1.73m2 , P = 0.09] were similar, while plasma cystatin C [from 1.50 (1.20-2.27) mg/L to 1.78 (1.33-2.59) mg/L, P < 0.001] and neutrophil gelatinase associated lipocalin (NGAL) [from 127 (95-260) ng/mL to 167 (104-263) ng/mL, P = 0.004] increased during hospitalization in AHF. Conclusions: Echocardiographic parameters and plasma biomarkers of cardiac and venous pressures improved during AHF hospitalization in both acute HFPEF and HFREF patients, while cardiac chamber dimensions, cardiac output, and estimated plasma volume showed minimal changes.
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hal-02885307 , version 1 (30-06-2020)

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Eiichi Akiyama, Raphaël Cinotti, Kamilė Čerlinskaitė, Lucas N L van Aelst, Mattia Arrigo, et al.. Improved cardiac and venous pressures during hospital stay in patients with acute heart failure: an echocardiography and biomarkers study. ESC Heart Failure, 2020, 7 (3), pp.996-1006. ⟨10.1002/ehf2.12645⟩. ⟨hal-02885307⟩
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