Key result
Each higher ultrasonographic cardiac damage stage is linked to ~59% higher mortality and HF rehospitalization.
Why the study?
Available HF risk stratification strategies largely rely on LVEF and symptom severity, which may lack pathophysiological reasoning. This study evaluated the prognostic impact of an ultrasonographic cardiac damage staging scheme combining cardiac and extra-cardiac information in hospitalized acute HF patients.
Does an ultrasonographic cardiac damage staging scheme integrating cardiac and extra-cardiac information predict all-cause mortality and heart failure rehospitalization in hospitalized acute heart failure patients?
Cohort (n=490)
Does an ultrasonographic cardiac damage staging scheme integrating cardiac and extra-cardiac information predict all-cause mortality and heart failure rehospitalization in hospitalized acute heart failure patients?
A novel pre-discharge ultrasonographic staging scheme integrating cardiac, pulmonary, and systemic venous congestion independently stratifies the risk of death and rehospitalization in patients with acute heart failure.
May aid pre-discharge risk stratification in acute HF; leaves open prospective validation before guiding therapy.
Background Available risk stratification strategies in heart failure (HF) largely rely on left ventricular ejection fraction and symptoms severity, which may lack pathophysiological reasoning. The aim of this study was to evaluate the prognostic impact of an ultrasonographic cardiac damage staging scheme using cardiac and extra-cardiac information in hospitalized acute HF patients. Methods Consecutive hospitalized acute HF patients underwent cardiac and extra-cardiac ultrasonographic evaluation before discharge, including assessment of B-lines with lung ultrasound and venous congestion assessment with the venous excess ultrasound score. The extent of cardiac damage was classified in four groups: Stage 1-2 (left ventricular and left atrial damage), Stage 3 (pulmonary damage), Stage 4 (right ventricular damage), and Stage 5 (systemic venous damage). The primary endpoint was all-cause mortality and HF rehospitalization. Results Out of the 490 patients included (73.4±11.9 years old, 59.4% male), 87 (17.8%) were classified in Stage 1-2, 129 (26.3%) in Stage 3, 134 (27.3%) in Stage 4, and 140 (28.6%) in Stage 5. After a mean follow-up of 12.0±2.6 months, 186 (38.0%) patients reached the primary endpoint. A stepwise increase in the percentage of cumulative events was observed across higher stages of cardiac damage (Stage 1-2: 17.2% , Stage 3: 29.5%, Stage 4: 32.8%, Stage 5: 63.6%, Log-rank p <0.001) (Picture 1, 2). On multivariable analysis, NT-pro-BNP, hemoglobin, and the stage of cardiac damage were independently associated with the primary endpoint. For each increasing group, there was a 59% higher risk for the primary endpoint (adjusted hazard ratio 1.59 [95% CI, 1.29 – 1.96]; p <0.001). Conclusions In hospitalized acute HF patients, a novel ultrasonographic cardiac damage staging scheme integrating cardiac and extra-cardiac information may help refine risk stratification at discharge.Picture 1Picture 2
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Anastasiou et al. (2026) conducted a cohort in Acute heart failure (n=490). Ultrasonographic cardiac damage staging (Stage 1-2 to Stage 5) vs. Lower stages of cardiac damage (Stage 1-2) was evaluated on All-cause mortality and heart failure rehospitalization (HR 1.59, 95% CI 1.29-1.96, p=<0.001). Each increasing ultrasonographic stage of cardiac damage was associated with a 59% higher risk of all-cause mortality and HF rehospitalization (adjusted HR 1.59; 95% CI 1.29-1.96; p<0.001).
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