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A novel echocardiographic hemodynamic classification of heart failure based on stroke volume index and left atrial pressure
Author(s) -
Abbas Amr E.,
Khoury Abdulla Rami,
Aggrawal Anshul,
Crile Jason,
Lester Steven J.,
Boura Judy
Publication year - 2017
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13642
Subject(s) - medicine , cardiology , stroke volume , hemodynamics , heart failure , ejection fraction , cardiac index , stroke (engine) , heart failure with preserved ejection fraction , cardiac output , blood pressure , mechanical engineering , engineering
Background and Aim Dividing patients with heart failure ( HF ) based solely on ejection fraction ( EF ) may over simplify the hemodynamic states of these patients. We describe a novel echo‐derived hemodynamic HF model based on flow (stroke volume index [ SVI ]) and left atrial pressure (E:E′) correlates. Methods A retrospective analysis of patients admitted with HF with both reduced ( HF r EF ) and preserved EF ( HF p EF ). Patients were subdivided into four hemodynamic groups based on echocardiographic SVI (< or ≥35 mL/m 2 ) and E/E′ (≥ or <15). Group A: normal flow and normal filling pressure, Group B: normal flow but high filling pressure, Group C: low flow and low filling pressure, and Group D: low flow and high filling pressure. Results A total of 176 patients were enrolled, 123 patients had HF r EF and 53 patients had HF p EF . Baseline characteristics were not statistically significant in both groups. In HF r EF , most patients were in group D compared to a heterogeneous distribution in HF p EF ( P <.0001). In HF r EF , there was a trend toward an increase in B‐type natriuretic peptide levels with a decrease in SVI and increase in E/E′ ( P =.05) but not in HF p EF . There was no difference in death, major adverse cardiac events, but a higher readmissions rate in the HF p EF group at 30 days and 18 months. Conclusions Hemodynamic subgroups differ between HF r EF and HF p EF . There is no difference in major adverse cardiovascular events between both groups with increased readmissions in HP p EF patients. Larger studies may help assess the impact of echo‐derived hemodynamic state on clinical outcome.