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Diamond-Forrester classification using echocardiography haemodynamic assessment in cardiac intensive care unit

Kyung-Hee Kim1,2, Jacob C Jentzer3,4, Brandon M Wiley3,4

  • 1Department of Cardiovascular Medicine, Echocardiography Laboratory, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.

ESC Heart Failure
|September 18, 2021
PubMed

Insights

The Diamond-Forrester classification, using Doppler echocardiography, effectively predicts hospital mortality in cardiac intensive care unit (CICU) patients. This non-invasive method identifies hemodynamic profiles that correlate with increased mortality risk.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Echocardiography

Background:

  • The Diamond-Forrester classification is a tool used to categorize hemodynamic profiles.
  • Non-invasive hemodynamic assessment is crucial for managing critically ill cardiac patients.

Purpose of the Study:

  • To evaluate the predictive value of the Diamond-Forrester classification for hospital mortality in cardiac intensive care unit (CICU) patients.
  • To assess the utility of 2-D and Doppler echocardiography in determining hemodynamic profiles and their association with patient outcomes.

Main Methods:

  • Retrospective analysis of 4563 patients admitted to a CICU between 2007 and 2018.
  • Classification into four hemodynamic profiles (warm/dry, warm/wet, cold/dry, cold/wet) using Doppler-derived cardiac index (CI) and E/e' ratio.
  • Logistic regression and Cox proportional-hazards analysis to determine predictors of in-hospital and one-year mortality.

Main Results:

  • Patients with low CI or elevated E/e' ratio exhibited higher in-hospital and one-year mortality rates.
  • Profiles II (warm/wet) and IV (cold/wet), characterized by elevated E/e' ratio, were associated with increased risk of death.
  • Multivariate analysis confirmed an increased risk of death for patients in Profiles II and IV (adjusted hazard ratios 1.72 and 2.17 for one-year mortality, respectively).

Conclusions:

  • Doppler echocardiography can reliably identify Diamond-Forrester hemodynamic profiles in CICU patients.
  • These identified hemodynamic profiles serve as significant predictors of patient outcomes.
  • The classification may guide therapeutic strategies for critically ill cardiac patients.
Abstract

Keywords:
CICUForrester classificationNon-invasive monitoring

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