Pulsatile hemodynamics and clinical outcomes in acute heart failure

The role of pulsatile hemodynamics in the management of patients with acute heart failure syndrome (AHFS) remains to be elucidated. We investigated the changes of the pulsatile hemodynamics along the hospital course of AHFS in relation to short-term outcomes.

A total of 80 AHFS patients (73.2 ± 14.1 years, 82.5% men) were enrolled and followed up for up to 6 months after discharge. Measures of the pulsatile hemodynamics including brachial and central systolic blood pressure (SBP) and pulse (PP) pressure, carotid-femoral pulse wave velocity (cf-PWV), carotid augmentation index (cAI and cAI(75)) and carotid augmented pressure (cAP) were obtained within 24 h of admission, before discharge, and 2 weeks after discharge.

During a follow-up of 174 ± 32 days (16-183 days), 29 patients experienced events including rehospitalization for heart failure, nonfatal myocardial infarction, nonfatal stroke, and mortality. Predischarge brachial and central PP, and cAP, and postdischarge brachial and central SBP and PP, cAP, and cf-PWV were significantly lower in patients without events than those with events. Predischarge central PP (hazard ratio per 1-s.d. and 95% confidence interval: 1.62 (1.12-2.34)) and cAP (1.47 (1.05-2.05)) predicted events independent of age and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Similarly, postdischarge brachial and central SBP and PP, cAP, and cf-PWV were also significant independent predictors.

Suboptimal recovery of the perturbations of the pulsatile hemodynamics in patients hospitalized due to AHFS may relate to adverse short-term outcomes and warrant aggressive treatment.