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Non-invasive assessment of acute heart failure by Stevenson classification: Does echocardiographic examination
Alberto Palazzuoli1, Gaetano Ruocco2, Serafina Valente3
1Cardiovascular Diseases Unit, Cardio Thoracic Department, Le Scotte Hospital, University of Siena, Siena, Italy.
Insights
This study found that while the Stevenson classification for acute heart failure is useful, combining it with echocardiography provides a more detailed patient profile. Group D (cold and wet) showed increased mortality.
Area of Science:
- Cardiology
- Medical Diagnostics
- Clinical Research
Background:
- Acute heart failure (AHF) is classified using the Stevenson diagram based on congestion and perfusion.
- The study aimed to correlate clinical assessment with echocardiographic findings in AHF patients.
Purpose of the Study:
- To evaluate the relationship between clinical and echocardiographic assessments in patients presenting with AHF.
- To determine if echocardiographic parameters can refine the Stevenson classification of AHF.
Main Methods:
- Retrospective, blinded, multicenter analysis of 208 AHF patients.
- Patients categorized into four Stevenson groups (A, B, C, D).
- Echocardiographic parameters including LV volumes, LVEF, E/e', PASP, TAPSE, and ICV measured within 12 hours of admission.
Main Results:
- Warm groups (A & C) had higher systolic pressures and LVEF compared to cold groups (B & D).
- Group B showed significantly lower TAPSE values.
- No significant difference in echocardiographic congestion scores among groups.
- Group D (cold and wet) exhibited a significantly increased mortality rate.
Conclusions:
- The Stevenson classification remains a valuable tool for assessing AHF congestion and perfusion.
- Integrating echocardiography with clinical assessment offers a more comprehensive patient profile.
- Echocardiographic findings may help identify high-risk AHF patients, such as those in Group D.
Background:
Acute heart failure (AHF) presentation is universally classified in relation to the presence or absence of congestion and the peripheral perfusion condition according to the Stevenson diagram. We sought to evaluate a relationship existing between clinical assessment and echocardiographic evaluation in patients with AHF.
Materials And Methods:
This is a retrospective blinded multicenter analysis assessing both clinical and echocardiographic analyses during the early hospital admission for AHF. Patients were categorized into four groups according to the Stevenson presentation: group A (warm and dry), group B (cold and dry), group C (warm and wet), and group D (cold and wet). Echocardiographic evaluation was executed within 12 h from the first clinical evaluation. The following parameters were measured: left ventricular (LV) volumes, LV ejection fraction (LVEF); pattern Doppler by E/e1 ratio, pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE), and inferior cave vein diameter (ICV).
Results:
We studied 208 patients, 10 in group A, 16 in group B, 153 in group C, and 29 in group D. Median age of our sample was 81 [69-86] years and the patients enrolled were mainly men (66.8%). Patients in groups C and A showed significant higher levels of systolic arterial pressures with respect to groups B and D (respectively, 130 [115-145] mmHg vs. 122 [119-130] mmHg vs. 92 [90-100] mmHg vs. 95 [90-100] mmHg, p < 0.001). Patients in groups A and C (warm) demonstrated significant higher values of LVEF with respect to patients in groups B and D (43 [34-49] vs. 42 [30-49] vs. 27 [15-31] vs. 30 [22-42]%, p < 0.001). Whereas group B experienced significant lower TAPSE values compared with other group (14 [12-17] mm vs. A: 17 [16-21] mm vs. C: 18 [14-20] mm vs. D: 16 [12-17] mm; p = 0.02). Finally, echocardiographic congestion score including PASP ≥ 40 mmHg, ICV ≥ 21, mm and E/e' > 14 did not differ among groups. Follow-up analysis showed an increased mortality rate in D group (HR 8.2 p < 0.04).
Conclusion:
The early Stevenson classification remains a simple and universally recognized approach for the detection of congestion and perfusion status. The combined clinical and echocardiographic assessment may be useful to better define the patients' profile.
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