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Vol 19 (2024): Continuous Publishing
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Published online: 2024-04-08

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Echocardiographic Parameters and Dyspnea During Treatment of Acute Decompensated Heart Failure

Kamil Bugała1, Piotr Bijak1, Leszek Drabik2, Wojciech Płazak2
DOI: 10.5603/fc.97096

Abstract

Introduction. Decongestion therapy of acute decompensated heart failure (ADHF) leads to significant haemodynamic and heart rate changes. The purpose of the study was to evaluate the impact of decongestion therapy and heart rate reduction on changes in echocardiographic parameters in patients hospitalized due to ADHF.

Material and methods. In 34 consecutive adult patients (41.2% females, mean age 70.2 ± 10.8 years) who required hospitalization due to ADHF, an echocardiographic assessment was performed upon admission and at discharge together with clinical and laboratory evaluation.

Results. Significant reductions in body weight (84.22 ± 17.46 vs. 78.72 ± 16.95 kg, p < 0,001), heart rate (86.21 ± 15.7 vs. 75.72 ± 11.01 bpm, p < 0.001) and NT-proBNP level (7530.22 ± 5192.52 vs. 3270.32 ± 2947.26 pg/mL, p = 0.001) were found. In the group of patients with a weight reduction of at least 5 kg, a significant decrease in dyspnoea severity was assessed with 0–100 points VAS scale (at admission/discharge ΔVAS 42.14 ± 13.68 vs. 30.00 ± 12.79, p = 0.04), tricuspid regurgitation peak gradient (ΔTRPG 7.53 ± 9.36 vs. 1.91 ± 7.48 mm Hg, p = 0.05) and mitral regurgitation severity (ΔMR VC 1.21 ± 0.65 vs. 0.66 ± 0.77 mm, p = 0.05) were observed. The subgroup of patients with heart rate reduction over 10 bpm exhibited a significant increase in left ventricular (LV) ejection fraction (HR reduction > 10 bpm: at admission 30.56 ± 13.96; at discharge 38.69 ± 13.29 vs. HR reduction < 10 bpm 42.64 ± 14.95; 41.91 ± 13.46 %, p = 0.02), and LV outflow velocity time integral (HR reduction > 10 bpm: at admission 12.61 ± 3.64; at discharge 15.55 ± 4.88 vs. HR reduction < 10 bpm: 16.18 ± 5.64; 15.04 ± 4.45 cm, p = 0.04).

Conclusions. Treatment of fluid overload in ADHF results mainly in dyspnoea reduction, mitral regurgitation decrease and pulmonary pressure lowering. Heart rate reduction is followed by a significant increase in LV stroke volume and LV ejection fraction. Such echocardiographic changes are expected during successful ADHF treatment. Their absence may direct the attention of the attending physician to the need for more aggressive treatment or a worse prognosis for the patients.

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