Utility of Left Atrial Expansion Index and Stroke Volume in Management of Chronic Systolic Heart Failure

Shih Hung Hsiao, Shih Kai Lin, Yi Ran Chiou, Chin Chang Cheng, Hwong Ru Hwang, Kuan Rau Chiou

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Titration of evidence-based medications, important for treating heart failure (HF), is often underdosed by symptom-guided treatment. The aim of this study was to investigate, using echocardiographic parameters, stroke volume and left ventricular (LV) filling pressure to guide up-titration of medications, increasing prognostic benefits. Methods: A total of 765 patients with chronic HF and severely reduced LV ejection fractions (<35%), referred from 2008 to 2016, were prospectively studied. Echocardiographic guidance was performed in 149 patients. LV filling pressure was assessed by left atrial expansion index, and stroke volume was estimated from diameter and time-velocity integral in the LV outflow tract. Up-titration of evidence-based medications and adjustment for side effects or worsening clinical conditions according to those parameters were performed. Propensity score matching was used to match pairs of patients with (n = 110) or without (n = 110) echocardiographic guidance. End points were 4-year frequencies of HF hospitalization and all-cause mortality. Results: During a mean follow-up time of 4.1 years, rates of adverse events were 58 (52.7%) with no echocardiographic guidance and 36 (32.7%) with echocardiographic guidance (P <.0001). Echocardiography provided effective guidance to reduce prescribing frequency and dose of diuretics and to promote evidence-based medication prescription. It reduced HF rehospitalization and all-cause mortality. By multivariate analysis, prognostic improvement was associated with up-titration of medications with echocardiographic guidance. Conclusions: There was a statistically significant difference in long-term prognosis between propensity score–matched pairs of patients with chronic severe HF with and without echocardiographic guidance. These findings need further validation in large prospective clinical trials.

Original languageEnglish
Pages (from-to)650-659.e1
JournalJournal of the American Society of Echocardiography
Volume31
Issue number6
DOIs
Publication statusPublished - Jun 1 2018

Fingerprint

Systolic Heart Failure
Stroke Volume
Heart Failure
Ventricular Pressure
Propensity Score
Mortality
Diuretics
Prescriptions
Echocardiography
Hospitalization
Multivariate Analysis
Clinical Trials

Keywords

  • All-cause mortality
  • Echocardiographic guidance
  • Left atrial expansion index
  • Severe systolic heart failure
  • Stroke volume

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Utility of Left Atrial Expansion Index and Stroke Volume in Management of Chronic Systolic Heart Failure. / Hsiao, Shih Hung; Lin, Shih Kai; Chiou, Yi Ran; Cheng, Chin Chang; Hwang, Hwong Ru; Chiou, Kuan Rau.

In: Journal of the American Society of Echocardiography, Vol. 31, No. 6, 01.06.2018, p. 650-659.e1.

Research output: Contribution to journalArticle

Hsiao, Shih Hung ; Lin, Shih Kai ; Chiou, Yi Ran ; Cheng, Chin Chang ; Hwang, Hwong Ru ; Chiou, Kuan Rau. / Utility of Left Atrial Expansion Index and Stroke Volume in Management of Chronic Systolic Heart Failure. In: Journal of the American Society of Echocardiography. 2018 ; Vol. 31, No. 6. pp. 650-659.e1.
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AU - Lin, Shih Kai

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AU - Cheng, Chin Chang

AU - Hwang, Hwong Ru

AU - Chiou, Kuan Rau

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N2 - Background: Titration of evidence-based medications, important for treating heart failure (HF), is often underdosed by symptom-guided treatment. The aim of this study was to investigate, using echocardiographic parameters, stroke volume and left ventricular (LV) filling pressure to guide up-titration of medications, increasing prognostic benefits. Methods: A total of 765 patients with chronic HF and severely reduced LV ejection fractions (<35%), referred from 2008 to 2016, were prospectively studied. Echocardiographic guidance was performed in 149 patients. LV filling pressure was assessed by left atrial expansion index, and stroke volume was estimated from diameter and time-velocity integral in the LV outflow tract. Up-titration of evidence-based medications and adjustment for side effects or worsening clinical conditions according to those parameters were performed. Propensity score matching was used to match pairs of patients with (n = 110) or without (n = 110) echocardiographic guidance. End points were 4-year frequencies of HF hospitalization and all-cause mortality. Results: During a mean follow-up time of 4.1 years, rates of adverse events were 58 (52.7%) with no echocardiographic guidance and 36 (32.7%) with echocardiographic guidance (P <.0001). Echocardiography provided effective guidance to reduce prescribing frequency and dose of diuretics and to promote evidence-based medication prescription. It reduced HF rehospitalization and all-cause mortality. By multivariate analysis, prognostic improvement was associated with up-titration of medications with echocardiographic guidance. Conclusions: There was a statistically significant difference in long-term prognosis between propensity score–matched pairs of patients with chronic severe HF with and without echocardiographic guidance. These findings need further validation in large prospective clinical trials.

AB - Background: Titration of evidence-based medications, important for treating heart failure (HF), is often underdosed by symptom-guided treatment. The aim of this study was to investigate, using echocardiographic parameters, stroke volume and left ventricular (LV) filling pressure to guide up-titration of medications, increasing prognostic benefits. Methods: A total of 765 patients with chronic HF and severely reduced LV ejection fractions (<35%), referred from 2008 to 2016, were prospectively studied. Echocardiographic guidance was performed in 149 patients. LV filling pressure was assessed by left atrial expansion index, and stroke volume was estimated from diameter and time-velocity integral in the LV outflow tract. Up-titration of evidence-based medications and adjustment for side effects or worsening clinical conditions according to those parameters were performed. Propensity score matching was used to match pairs of patients with (n = 110) or without (n = 110) echocardiographic guidance. End points were 4-year frequencies of HF hospitalization and all-cause mortality. Results: During a mean follow-up time of 4.1 years, rates of adverse events were 58 (52.7%) with no echocardiographic guidance and 36 (32.7%) with echocardiographic guidance (P <.0001). Echocardiography provided effective guidance to reduce prescribing frequency and dose of diuretics and to promote evidence-based medication prescription. It reduced HF rehospitalization and all-cause mortality. By multivariate analysis, prognostic improvement was associated with up-titration of medications with echocardiographic guidance. Conclusions: There was a statistically significant difference in long-term prognosis between propensity score–matched pairs of patients with chronic severe HF with and without echocardiographic guidance. These findings need further validation in large prospective clinical trials.

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KW - Echocardiographic guidance

KW - Left atrial expansion index

KW - Severe systolic heart failure

KW - Stroke volume

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