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Predictors of low cardiac output in decompensated severe heart failure

OBJECTIVE: To identify predictors of low cardiac output and mortality in decompensated heart failure. INTRODUCTION: Introduction: Patients with decompensated heart failure have a high mortality rate, especially those patients with low cardiac output. However, this clinical presentation is uncommon,...

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Autores principales: Ochiai, Marcelo Eidi, Cardoso, Juliano Novaes, Vieira, Kelly Regina Novaes, Lima, Marcelo Villaça, Brancalhao, Euler Cristovan Ochiai, Barretto, Antonio Carlos Pereira
Formato: Texto
Lenguaje:English
Publicado: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo 2011
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3059880/
https://www.ncbi.nlm.nih.gov/pubmed/21484040
http://dx.doi.org/10.1590/S1807-59322011000200010
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author Ochiai, Marcelo Eidi
Cardoso, Juliano Novaes
Vieira, Kelly Regina Novaes
Lima, Marcelo Villaça
Brancalhao, Euler Cristovan Ochiai
Barretto, Antonio Carlos Pereira
author_facet Ochiai, Marcelo Eidi
Cardoso, Juliano Novaes
Vieira, Kelly Regina Novaes
Lima, Marcelo Villaça
Brancalhao, Euler Cristovan Ochiai
Barretto, Antonio Carlos Pereira
author_sort Ochiai, Marcelo Eidi
collection PubMed
description OBJECTIVE: To identify predictors of low cardiac output and mortality in decompensated heart failure. INTRODUCTION: Introduction: Patients with decompensated heart failure have a high mortality rate, especially those patients with low cardiac output. However, this clinical presentation is uncommon, and its management is controversial. METHODS: We studied a cohort of 452 patients hospitalized with decompensated heart failure with an ejection fraction of <0.45. Patients underwent clinical‐hemodynamic assessment and Chagas disease immunoenzymatic assay. Low cardiac output was defined according to L and C clinical‐hemodynamic profiles. Multivariate analyses assessed clinical outcomes. P<0.05 was considered significant. RESULTS: The mean age was 60.1 years; 245 (54.2%) patients were >60 years, and 64.6% were men. Low cardiac output was present in 281 (63%) patients on admission. Chagas disease was the cause of heart failure in 92 (20.4%) patients who had higher B type natriuretic peptide levels (1,978.38 vs. 1,697.64 pg/mL; P = 0.015). Predictors of low cardiac output were Chagas disease (RR: 3.655, P<0.001), lower ejection fraction (RR: 2.414, P<0.001), hyponatremia (RR: 1.618, P = 0.036), and renal dysfunction (RR: 1.916, P = 0.007). Elderly patients were inversely associated with low cardiac output (RR: 0.436, P = 0.001). Predictors of mortality were Chagas disease (RR: 2.286, P<0.001), ischemic etiology (RR: 1.449, P = 0.035), and low cardiac output (RR: 1.419, P = 0.047). CONCLUSIONS: In severe decompensated heart failure, predictors of low cardiac output are Chagas disease, lower ejection fraction, hyponatremia, and renal dysfunction. Additionally, Chagas disease patients have higher B type natriuretic peptide levels and a worse prognosis independent of lower ejection fraction.
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spelling pubmed-30598802011-03-17 Predictors of low cardiac output in decompensated severe heart failure Ochiai, Marcelo Eidi Cardoso, Juliano Novaes Vieira, Kelly Regina Novaes Lima, Marcelo Villaça Brancalhao, Euler Cristovan Ochiai Barretto, Antonio Carlos Pereira Clinics (Sao Paulo) Clinical Science OBJECTIVE: To identify predictors of low cardiac output and mortality in decompensated heart failure. INTRODUCTION: Introduction: Patients with decompensated heart failure have a high mortality rate, especially those patients with low cardiac output. However, this clinical presentation is uncommon, and its management is controversial. METHODS: We studied a cohort of 452 patients hospitalized with decompensated heart failure with an ejection fraction of <0.45. Patients underwent clinical‐hemodynamic assessment and Chagas disease immunoenzymatic assay. Low cardiac output was defined according to L and C clinical‐hemodynamic profiles. Multivariate analyses assessed clinical outcomes. P<0.05 was considered significant. RESULTS: The mean age was 60.1 years; 245 (54.2%) patients were >60 years, and 64.6% were men. Low cardiac output was present in 281 (63%) patients on admission. Chagas disease was the cause of heart failure in 92 (20.4%) patients who had higher B type natriuretic peptide levels (1,978.38 vs. 1,697.64 pg/mL; P = 0.015). Predictors of low cardiac output were Chagas disease (RR: 3.655, P<0.001), lower ejection fraction (RR: 2.414, P<0.001), hyponatremia (RR: 1.618, P = 0.036), and renal dysfunction (RR: 1.916, P = 0.007). Elderly patients were inversely associated with low cardiac output (RR: 0.436, P = 0.001). Predictors of mortality were Chagas disease (RR: 2.286, P<0.001), ischemic etiology (RR: 1.449, P = 0.035), and low cardiac output (RR: 1.419, P = 0.047). CONCLUSIONS: In severe decompensated heart failure, predictors of low cardiac output are Chagas disease, lower ejection fraction, hyponatremia, and renal dysfunction. Additionally, Chagas disease patients have higher B type natriuretic peptide levels and a worse prognosis independent of lower ejection fraction. Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo 2011-02 /pmc/articles/PMC3059880/ /pubmed/21484040 http://dx.doi.org/10.1590/S1807-59322011000200010 Text en Copyright © 2011 Hospital das Clínicas da FMUSP http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Science
Ochiai, Marcelo Eidi
Cardoso, Juliano Novaes
Vieira, Kelly Regina Novaes
Lima, Marcelo Villaça
Brancalhao, Euler Cristovan Ochiai
Barretto, Antonio Carlos Pereira
Predictors of low cardiac output in decompensated severe heart failure
title Predictors of low cardiac output in decompensated severe heart failure
title_full Predictors of low cardiac output in decompensated severe heart failure
title_fullStr Predictors of low cardiac output in decompensated severe heart failure
title_full_unstemmed Predictors of low cardiac output in decompensated severe heart failure
title_short Predictors of low cardiac output in decompensated severe heart failure
title_sort predictors of low cardiac output in decompensated severe heart failure
topic Clinical Science
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3059880/
https://www.ncbi.nlm.nih.gov/pubmed/21484040
http://dx.doi.org/10.1590/S1807-59322011000200010
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