Observational Study for Multiparametric Assessment of Cardiac Congestion in Outpatient Worsening Heart Failure (EVOLUTION)

Figures

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  Figure 1. Schema for fluid expansion and diuretic administration at week 4 visit. HF, heart failure; IV, intravenous; sx, symptoms.

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  Figure 2. Changes in patient‐reported dyspnoea over the 4 weeks following an outpatient worsening heart failure event. Individual patients' trajectories are overlaid with means and standard errors from a mixed model for repeated measures including the effects of baseline value, visit, and baseline × visit. Dyspnoea was reported on a scale from 0 = none to 10 = very severe/maximal.

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  Figure 3. Changes in 12‐question Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score over the 4 weeks following an outpatient worsening heart failure event. Individual patients' trajectories are overlaid with means and standard errors from a mixed model for repeated measures including the effects of baseline value, visit, and baseline × visit. The KCCQ overall summary score ranges from 0 to 100 with a higher score indicating better health status.

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  Figure 4. Heat map showing p‐values from univariable logistic regression models of the association of each baseline characteristic with being a ‘responder’ on each measure of improvement 4 weeks after an outpatient worsening heart failure event. p‐values <0.20 are shaded (green for positive associations and red for negative associations), with darker shading representing more highly statistically significant associations. Bio‐ADM, bio‐adrenomedullin; eGFR, estimated glomerular filtration rate; HF, heart failure; IL‐6, interleukin‐6; IVC, inferior vena cava; KCCQ, Kansas City Cardiomyopathy Questionnaire; LAV, left atrial volume; LVEDV, left ventricular end‐diastolic volume; LVEF, left ventricular ejection fraction; NGAL, neutrophil gelatinase‐associated lipocalin; NT‐proBNP, N‐terminal pro‐B‐type natriuretic peptide; NYHA, New York Heart Association; PenKid, proenkephalin A 119–159; SBP, systolic blood pressure.

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  Figure 5. Combination of baseline biomarkers exceeding identified thresholds predictive of response to fluid challenge. Comparative analysis of heart failure patients grouped by exceeding baseline biomarker thresholds: high‐sensitivity troponin T >20 ng/L, N‐terminal pro‐B‐type natriuretic peptide >1500 ng/L, and cystatin C >1.2 mg/L. Groups 0–3 reflect the count of biomarkers exceeding thresholds. Data are presented as bars with mean or percent. NoRales, no rales (%) at week 4 h 6; Diuresis, diuresis (ml) at week 4 hours 3–6; Natriuresis, natriuresis (ml) at week 4 hours 3–6.