Pulsatile Hemodynamics and Clinical Outcomes in Patients with Acute Heart Failure Syndrome

• Main Authors: Shih-Hsien Sung, 宋思賢
• Other Authors: Chen-Huan Chen
• Format: Others
• Language: en_US
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/znyk28

博士 === 國立陽明大學 === 公共衛生研究所 === 103 === Heart failure (HF) is a major public health problem in Taiwan. Over the past two decades, although there have been significant advances in the treatment of HF, morbidity and mortality remain high. Furthermore, at least one-third of the patients who had ever been admitted for acute heart failure (AHF) would have post-discharge adverse events, including rehospitalization for AHF, within 3 to 6 months. While N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been a remarkable biomarker to improve the clinical diagnosis and risk stratification of HF, customized therapy for HF guided by NT-proBNP has not produced better clinical outcomes. On the other hand, pulsatile hemodynamics, including pulse pressure, arterial stiffness by carotid-femoral arterial stiffness (cf-PWV), and measures of wave reflections intensity, are important in the pathogenesis of HF. We hypothesized that pulsatile hemodynamics indices may become a marker to predict risks of AHF and guide drug therapy. In the present works, we conducted a series of hemodynamic studies majorly in patients with AHF. In patients presenting with dyspnea on exertion but without history of HF, common carotid artery stiffness was associated with either left ventricular systolic or diastolic function, independent of cf-PWV, and it could predict the development of AHF thereafter. In patients hospitalized for AHF, the on-admission, pre-discharge, and post-discharge measures of wave reflections intensity and pulse pressure were independently related to re-hospitalization for HF and death. In contrast, among AHF patients who had no post-discharge events within 3 months of discharge, cf-PWV but not wave reflections measured at 3 months of discharge predicted long term outcomes independently of NT-proBNP. In summary, the presented works may support wave reflections as a possible mechanical biomarker in AHF for short-term risk stratification and tailored drug therapy. In contrast, arterial stiffness may provide long-term prognostic value in patients with CHF. Given the non-modifiable nature of arterial stiffness by current anti-heart failure medications, there is indeed an unmet need to develop new drugs to improve arterial stiffness.