The mixed severe congestion phenotype was associated with significantly higher in-hospital mortality compared to low-low and pulmonary-dominant phenotypes (11.2% vs 3.0% and 1.7%, OR 5.67).
Cohort (n=235)
No
Does ultrasound-derived congestion phenotyping combining B-lines and VExUS predict in-hospital mortality and correlate with cardiac remodeling in patients with acute decompensated HFpEF?
Ultrasound-derived congestion phenotyping combining B-lines and VExUS identifies a mixed severe phenotype in AHFpEF that is associated with advanced cardiac remodeling and significantly higher in-hospital mortality.
Odds Ratio: 5.67 (95% CI 1.27–25.28)
Absolute Event Rate: 11.2% vs 3%
p-value: p=0.023
Aim: To evaluate ultrasound-derived congestion phenotypes in acute decompensated heart failure with preserved ejection fraction (HFpEF) and their association with cardiac remodeling and in-hospital outcomes. Methods: This prospective study included 235 patients (median age 77.0 years, 75.3% women) with acute decompensated HFpEF. Within 2 hours of admission, all patients underwent echocardiography, lung ultrasound (B-lines), venous excess ultrasound score (VExUS) assessment, and bioimpedance analysis. Patients were classified into three phenotypes based on pulmonary (B-lines > 3) and systemic venous congestion (VExUS): low-low (no significant pulmonary or systemic congestion), pulmonary-dominant, and mixed severe. The primary endpoint was in-hospital mortality. Results: Moderate-to-severe venous congestion (VExUS grade 2–3) was present in 60.8% of patients. The mixed severe phenotype predominated (60.9%) and was associated with higher body mass index (BMI) and waist (p < 0.001). This group demonstrated more advanced cardiac dysfunction, including higher E/e’ (14.9 vs. 11.9; p < 0.001), greater left atrial remodeling (left atrial volume index 45.0 vs. 39.0 mL/m2; p < 0.001), and increased left ventricular mass index (p = 0.010). Right ventricular (RV) involvement was more pronounced, with lower TAPSE (18.0 vs. 20.0 mm; p < 0.001) and higher tricuspid regurgitation velocity (p < 0.001). Markers of congestion showed a gradient, with higher NT-proBNP (3,072.5 vs. 1,197.0 pg/mL; p < 0.001), increased extracellular water (129% vs. 101%; p < 0.001), and lower phase angle (4.9 vs. 5.5; p < 0.001). In-hospital mortality was highest in the mixed severe phenotype 11.2% vs. 3.0% and 1.7%; p = 0.039; odds ratio (OR) 5.67. B-lines correlated with tricuspid regurgitation velocity, E/e’, and extracellular water (all r ≥ 0.50). Conclusions: Ultrasound-derived congestion phenotyping in HFpEF identifies distinct profiles associated with atrial and ventricular remodeling and worse in-hospital outcomes. Future studies are required to determine whether phenotype-guided decongestive strategies can improve outcomes beyond risk stratification.
Рогожкина et al. (Wed,) conducted a cohort in Acute decompensated heart failure with preserved ejection fraction (AHFpEF) (n=235). Mixed severe congestion phenotype vs. Low-low and pulmonary-dominant congestion phenotypes was evaluated on In-hospital mortality (OR 5.67, 95% CI 1.27-25.28, p=0.023). The mixed severe congestion phenotype was associated with significantly higher in-hospital mortality compared to low-low and pulmonary-dominant phenotypes (11.2% vs 3.0% and 1.7%, OR 5.67).