Congestion-Perfusion Phenotypes and In-Hospital Mortality in Acute Heart Failure: Phenotype-Specific Prognostic...

Area of Science:

• Cardiology
• Internal Medicine
• Clinical Research

Background:

• Acute heart failure (AHF) presents with diverse clinical profiles and significant short-term mortality.
• Bedside assessment of congestion and perfusion can stratify AHF risk.
• This study investigates a novel congestion-perfusion classification for predicting AHF mortality.

Purpose of the Study:

• To evaluate the association between a non-invasive congestion-perfusion classification and in-hospital mortality in AHF patients.
• To explore the prognostic value of clinical, biological, and echocardiographic markers within identified phenotypes.

Main Methods:

• An observational study of 790 hospitalized AHF patients.
• Classification into four congestion-perfusion phenotypes: non-congested/preserved perfusion, congested/preserved perfusion, non-congested/impaired perfusion, and congested/impaired perfusion.
• Analysis of clinical, biological, and echocardiographic data, with ROC curve analysis and logistic regression for prognostic evaluation.

Main Results:

• In-hospital mortality varied significantly across phenotypes, with the highest rate (19.5%) in the congested/impaired perfusion group.
• Exploratory models showed good discriminatory performance for predicting mortality in congestive phenotypes (AUCs ranging from 0.693 to 0.785).
• Right ventricular parameters were strongly linked to mortality in the congested/impaired perfusion phenotype, while LVEF had limited predictive value.

Conclusions:

• The congested/impaired perfusion phenotype is associated with the highest in-hospital mortality and a more severe clinical profile.
• Prognostic marker patterns within congestive phenotypes showed partial overlap, with LVEF demonstrating limited discrimination.
• The congestion-perfusion classification provides a valuable tool for risk stratification in AHF.