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Evaluation Tools to Quantify Congestion and Prognostic Implication in Patients with Heart Failure

Abstract : Congestion expresses systemic and pulmonary edema associated with elevated intracardiac pressure, and is a major predictor of poor prognosis in heart failure (HF). Therefore, it is of paramount importance to better assess congestion at each point of patient management (i.e., before progression to decompensation, prior discharge assessment, outpatient clinic). Accumulated data highlighted that several evaluation tools of congestion can help clinicians diagnose acute HF and manage optimally patients with chronic HF or acutely decompensated HF. However, the availability of these congestion markers may limit their clinical utility. Readily and widely available evaluation tool is warranted to quantify and/or monitor congestion and eventually improve risk-stratification. Congestion score evaluated from chest radiography and plasma volume estimated from hemoglobin and hematocrit may provide relevant information in patients with HF. Our aims were; 1) to evaluate the diagnostic and prognostic performance of radiographic pulmonary congestion quantification in acute HF; 2) to evaluate the clinical and prognostic implications of estimated plasma volume (ePV) in HF; and 3) to assess the prognostic value of a combination of these congestion markers. We studied the diagnostic value of a radiographic congestion score for acute HF, and its prognostic value in acute HF. Our results showed that this score improved clinical-based diagnostic performance, and expressed residual congestion with poor prognostic value in acute HF. Regarding our second congestion marker of interest, ePV, we investigated its associations with biological, echocardiographic and hemodynamic markers of congestion and outcomes in different settings of HF (HF with preserved ejection fraction, and acute HF). Our results suggested that ePV appears as a left-sided congestion marker (i.e., natriuretic peptide) and an independent prognostic marker. Furthermore, we explored the prognostic value of the combination of radiographic congestion score and ePV on admission in patients hospitalized for worsening HF in different patient populations/managements (emergency department and cardiology department), and found that this bivariable approach had promising prognostic utility for in-hospital outcomes and post-discharge short-term outcomes. Our work provided the clinical relevance of radiographic pulmonary congestion scoring, ePV and their combination in patients with HF. Throughout our research, better performance of a combination of different type congestion markers was observed; thus, integration of multiple congestion markers might provide more pragmatic and clinically useful information about diagnosis for HF and prognosis in HF. Further research would be warranted.
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Submitted on : Friday, February 5, 2021 - 4:26:58 PM
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Masatake Kobayashi. Evaluation Tools to Quantify Congestion and Prognostic Implication in Patients with Heart Failure. Cardiology and cardiovascular system. Université de Lorraine, 2020. English. ⟨NNT : 2020LORR0165⟩. ⟨tel-03133121⟩

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