Predictors of low cardiac output in decompensated severe heart failure

Abstract

OBJECTIVE:To identify predictors of low cardiac output and mortality in decompensated heart failure.INTRODUCTION:Introduction: Patients with decompensated heart failure have a high mortality rate, especially those patients with low cardiac output. However, this clinical presentation is uncommon, and its management is controversial.METHODS:We studied a cohort of 452 patients hospitalized with decompensated heart failure with an ejection fraction of <0.45. Patients underwent clinical‐hemodynamic assessment and Chagas disease immunoenzymatic assay. Low cardiac output was defined according to L and C clinical‐hemodynamic profiles. Multivariate analyses assessed clinical outcomes. P<0.05 was considered significant.RESULTS:The mean age was 60.1 years; 245 (54.2%) patients were >60 years, and 64.6% were men. Low cardiac output was present in 281 (63%) patients on admission. Chagas disease was the cause of heart failure in 92 (20.4%) patients who had higher B type natriuretic peptide levels (1,978.38 vs. 1,697.64 pg/mL; P = 0.015). Predictors of low cardiac output were Chagas disease (RR: 3.655, P<0.001), lower ejection fraction (RR: 2.414, P<0.001), hyponatremia (RR: 1.618, P = 0.036), and renal dysfunction (RR: 1.916, P = 0.007). Elderly patients were inversely associated with low cardiac output (RR: 0.436, P = 0.001). Predictors of mortality were Chagas disease (RR: 2.286, P<0.001), ischemic etiology (RR: 1.449, P = 0.035), and low cardiac output (RR: 1.419, P = 0.047).CONCLUSIONS:In severe decompensated heart failure, predictors of low cardiac output are Chagas disease, lower ejection fraction, hyponatremia, and renal dysfunction. Additionally, Chagas disease patients have higher B type natriuretic peptide levels and a worse prognosis independent of lower ejection fraction.

Clinical usefulness of the definitions for defining characteristics of activity intolerance, excess fluid volume and decreased cardiac output in decompensated heart failure: a descriptive exploratory study

“…, Ochiai et al . ). The complexity of the medication therapy, associated with the low educational level of most patients, may have hindered patient adherence and contributed to subsequent disease decompensation (van der Wal et al .…”

“…A HF diagnosis can be made using the Boston criteria, considering the variables described in Table 1. Once diagnosed with HF, patients are classified using the four categories of the New York Heart Association (NYHA) Functional Classification, based on the severity of their symptoms during physical activity (Table 1) (Ochiai et al 2011). Decompensation leads to frequent hospitalisations and readmissions (Go et al 2014).…”

Short-term add-on therapy with angiotensin receptor blocker for end-stage inotrope-dependent heart failure patients: B-type natriuretic peptide reduction in a randomized clinical trial

“…In end-stage heart failure, patients frequently become dependent on inotrope, which predicts greater mortality (3). Generally, these patients die if they cannot receive a heart transplant, either because of clinical conditions or because of the lack of available donor organs.…”

Uso da monitorização hemodinâmica contínua não invasiva na insuficiência cardíaca descompensada

“…Decompensated heart failure in its most severe form requires prolonged hospitalization and use of intravenous medications, whether inotropic agents, vasodilators, or a combination of both 1 . Loop diuretics are the main drugs used in the treatment of hypervolemia, as most decompensated patients also suffer from congestion symptoms.…”