Clinical and paraclinical parameters with independent prognostic value in acute heart failure. Derivated risk scores in relation with clinical form

Introduction: A serie of clinical and paraclinical pa-rameters has proven a prognostic value in national and international records. In the last decade there was a major concern for the Acute Heart Failure (AHF) syndrome which refined the value of these parameters in relation to the clinical form.

Objective: Identification of clinical and paraclinical parameters with independent prognostic value (IPV) for short term in two severe form of AHF, Chronic Decompensated Heart Failure class IV NYHA (CDHF IV NYHA) and Acute Pulmonary Edema except for an Acute Coronary Syndrome (APE non-ACS). Develo-ping risk scores for intra-spital mortality (IM) based on these.

Methods: Were included 228 patients with severe form of AHF: CDHF IV NYHA and APE non-ACS, hospi-talized into the Cardiology department of Emergency Clinical Hospital „St. Pantelimon” Bucharest betwe-en 1st january – 31st decembre 2013; distributed and analyzed according to the clinical form. At the pre-sentation pre-terapeutic, clinical (blood pressure=BP, heart rate=HR), biological (urea, creatinine, hemo-globin, serum sodium) and echocardiographics para-meters (right and left cavity dimensions, systolic and diastolic function parameters of both ventricles, right atrio-ventricular gradient – RAVG – and acceleration time in pulmonary artery) were analyzed. Their IPV was identified relative to IM. Each parameter with IPV received one point. Scores were established relative to the clinical form.

Results: 136 patients with CDHF IV NYHA, 92 with APE non-ACS. The patients presented as APE non-ACS vs. CDHF IV NYHA have a higher IM risk, RR=1.1403, 95%CI 0.9993-1.3013, (p=0.05), this form of presenta-tion has been assigned a point in the score. Multiva-riate analysis has identified the following IPV para-meters for CDHF IV NYHA: systolic BP<100 mmHg (p=0.04), serum urea> 67 mg/dl (p=0.02), serum sodi-um<130 mEq/l (p<0.01), RAVG> 41 mmHg (p<0.01); respectively for APE non-ACS: serum sodium<130 mEq/l (p<0.01), LVEDD > 54 mm (p=0.01) and DT of E wave<196 ms (p=0.03). The prognostic value of each score relative to IM was: in CDHF IV NYHA score ≥ 1 (p=0.15), S≥ 2 (p=0.07), S≥ 3 (p=0.003), S≥ 4 (p<0.01); respectively for APE non-ACS, S≥ 1 (p=0.14), S≥ 2 (p=0.14), S≥ 3 (p=0.002), S≥ 4 (p<0.01).

Conclusions: A series of clinical and paraclinical pa-rameters that can be easily determined since the pre-sentation have shown IPV in our work. Risk scores, by combining them increase prognostic value and can help the clinician to identify early high-risk patients with terapeutic implications. Wider batches are requi-red to make the analysis not only depending on the cli-nical form and the substrate.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)