Early Worsening Heart Failure in Patients Admitted for Acute Heart Failure: Time Course,Hemodynamic Predictors,and Outcome |
| |
| Authors: | Guillermo Torre-Amione Olga Milo-Cotter Edo Kaluski Loic Perchenet Isaac Kobrin Aline Frey Michele M Rund Beth Davison Weatherley Gad Cotter |
| |
| Institution: | 1. Winters Center for Heart failure research, The Methodist Hospital, Baylor College of Medicine, Houston, Texas;2. Momentum Research Inc, Durham, NC;3. Cardiac Catheterization Laboratories, Department of Cardiology, University of Medicine and Dentistry, Newark, New Jersey;4. Actelion Pharmaceuticals, Alchwil, Switzerland;1. Arrhythmia Service, University of Western Ontario, London, Ontario, Canada;2. Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada;1. Institut Fédératif de Recherche, Université Lille Nord de France, Lille, France;2. Groupement Hospitalier de l’Institut Catholique Lillois, Université Lille Nord de France, and Faculté Libre de Médecine, Université Catholique de Lille, Lille, France;3. Cardiology Intensive Care Unit, Hôpital Européen Georges Pompidou, Paris, France;4. Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, Louisiana;1. Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea;2. Department of Mathematical and Statistical Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea;3. Department of Thoracic and Cardiovascular Surgery, Seoul Veterans Hospital, Seoul, Korea;1. Department of Pathophysiology, University of Split School of Medicine, Split, Croatia;2. University Hospital of Split, Split, Croatia;3. Department of Cardiology, University Hospital of Split, Split, Croatia;4. Department of Internal Medicine, University of Split School of Medicine, Split, Croatia;5. Working Group on Heart Failure of Croatian Cardiac Society, Croatia;1. Department of Cardiology, Fiona Stanley Hospital, Perth, Australia;2. Heart Care, Perth, Australia |
| |
| Abstract: | BackgroundThe most common outcome currently assessed in acute heart failure trials (AHF) is dyspnea improvement. Worsening hear failure (WHF) is a new outcome measure that incorporates failure to improve or recurrent symptoms of AHF requiring rescue intravenous therapy, mechanical circulatory or ventilatory support, or readmission because of AHF, occurring within 30 days of AHF admission.Methods and ResultsRetrospective data analysis of 120 patients with AHF requiring hemodynamic monitoring who enrolled in the placebo arm of 2 prospective randomized studies. The incidence of WHF was 42% at 30 days from enrollment. Most WHF events occurred in-hospital during the first 7 days after admission (early WHF). Thirty-day readmission from AHF was an infrequent event in the present cohort (5.0%). The strongest hemodynamic predictors of WHF were cardiac power at baseline and its change during the initial 6 hours of monitoring. Other hemodynamic parameters associated with WHF events were blood pressure and its increase, cardiac output, and pulmonary wedge pressure change during the initial 6 hours of monitoring. WHF was found to be a strong predictor of 6-month mortality.ConclusionsWHF is a common morbid event clustered mostly during the first week of AHF admission and is associated with higher 6-month mortality. The hemodynamic measurements associated with WHF are similar to those predicting adverse outcome in AHF and cardiogenic shock (low cardiac power, higher pulmonary capillary wedge pressure, and vascular resistance), emphasizing the notion that early WHF should become an important AHF-specific outcome measure. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
