Subclinical congestion was present in 38% of stable heart failure patients and was linked to worse NYHA class, lower LVEF, higher PASP, and renal/hepatic dysfunction.
Is subclinical congestion assessed by ultrasound common in stable heart failure patients and does it correlate with markers of disease severity?
Subclinical congestion detected by ultrasound (VEXUS protocol) is present in over a third of stable HF patients without overt clinical congestion and correlates with worse clinical, echocardiographic, and laboratory severity.
Absolute Event Rate: 0% vs 0%
Abstract Background HF has traditionally been considered a disease with low cardiac output. However, it is now known that congestion accounts for most patients' symptoms, and hospitalizations. Although physical examination is used to determine if the patient has congestion, recent evidence indicates that in some patients congestion may only be demonstrated through paraclinical methods. Hypothesis: Subclinical congestion will be common in stable HF patients, and it will be associated with markers of severity. Methods In this prospective cross-sectional study, stable (ambulatory) HF patients with LVEF50% and no more than + peripheral edema were included. Patients were invited to a specific visit where a comprehensive physical examination focused on congestion was carried out. In addition, the following studies were performed: A) A dedicated echocardiogram to assess the inferior vena cava, and pulmonary, hepatic and renal congestion by VEXUS Protocol; B) Bioimpedance for evaluation of extracellular and total body water. Subclinical congestion was defined as the presence of at least 1 marker of severe congestion, or 2 markers of moderate congestion. Results We included 36 patients (mean age 53±15 years, 67% male, 33% ischemic HF, mean LVEF 28±10%). Subclinical congestion was present in 38% of patients. Patients with subclinical congestion were more likely to have worse NYHA functional class, lower systolic blood pressure, and have more frequent abdominal fullness (P0.05 for all). Subclinical congestion was associated with higher E/A ratio, lower LVEF, and higher PASP (P0.05 for all). Finally, patients with subclinical congestion showed higher creatinine, bilirubin, and prothrombin time (P0.05 for all). NT-proBNP was available in only 42% of patients and was not statistically significant between groups (P0.05). Total body hydration and extracellular water were not statistically different between groups (P0.05). See Figure. Conclusions In patients without overt clinical congestion, subclinical congestion demonstrated by a dedicated ultrasound was common and associated with markers of heart failure severity. Table:Clinical and Echocardiographic Ch
Martinez et al. (Sat,) reported a other. Subclinical congestion was present in 38% of stable heart failure patients and was linked to worse NYHA class, lower LVEF, higher PASP, and renal/hepatic dysfunction.