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Predicting readmission for heart failure patients by echocardiographic assessment of elevated left atrial pressure

Kenichi Matsushita1, Junnosuke Ito2, Aoi Isaka2

  • 1Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan; Division of Advanced Cardiovascular Therapeutics, Department of Cardiovascular Medicine, Kumamoto University Hospital, Kumamoto 860-8556, Japan; Department of Cardiology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan; The Maruki Memorial Medical and Social Welfare Center, Saitama 350-0495, Japan; National Research Institute for Child Health and Development, Tokyo 157-8535, Japan.

The American Journal of the Medical Sciences
|August 10, 2023
PubMed

Insights

Elevated left atrial pressure (LAP) in heart failure (HF) patients, as assessed by echocardiography, significantly predicts HF readmission within one year. This validates the 2016 guidelines for clinical use.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Heart Failure Management

Background:

  • Elevated left ventricular (LV) filling pressure is a primary driver of heart failure (HF) readmissions.
  • The 2016 American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines offer a simplified method for assessing LV filling pressure via echocardiography.
  • Validation of this simplified algorithm in predicting HF readmission is crucial.

Purpose of the Study:

  • To validate the clinical utility of the 2016 ASE/EACVI guidelines for echocardiographic assessment of elevated left atrial pressure (LAP) in predicting HF readmission.
  • To identify high estimated LAP (eLAP) as a risk factor for HF readmission.

Main Methods:

  • Retrospective study of 139 acute decompensated HF patients.
  • Defined high eLAP based on 2016 ASE/EACVI guidelines.
  • Utilized univariate and multivariate logistic regression to analyze HF readmission risk factors within one year.

Main Results:

  • 49% had no high eLAP, 23% had indeterminate eLAP, and 28% had high eLAP.
  • HF readmission rates were 7.5%, 18.5%, and 33.3% for no high eLAP, indeterminate, and high eLAP groups, respectively.
  • High eLAP was a significant predictor of HF readmission (OR 5.924, P=0.006), confirmed by multivariate analysis and two-year follow-up.

Conclusions:

  • Echocardiographic assessment of elevated LAP using the 2016 ASE/EACVI guidelines is clinically valid.
  • This method effectively predicts readmission in patients with heart failure.
  • The findings support the routine use of this guideline-based assessment in HF management.
Abstract

Keywords:
CongestionEchocardiogramHeart failureIndividualized treatmentReadmission

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