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Clinic, biologic and echocardiographic particularities with short time prognosis value in severe clinical forms of acute heart failure

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Acute Heart Failure (AHF) is a clinical and paraclinical polymorphic syndrome, with high in hospital and early post discharge mortality. A few national and international registries have analysed, individually, the severe forms of AHF, Acute Pulmonary Edema (APE) or Chronic Decompensated Acute Heart Failure (CDAHF) IV NYHA Class.

Identifying clinical, biological and echocardiographic parameters with prognosis value for in hospital mortality (IHM) in a lot of patients with severe forms of AHF. Customizing them according to clinical form: APE without acute coronary syndrome (APE non ACS) or CDAHF IV NYHA class.

 

Methods: 228 patients with AHF severe clinical forms, admitted consecutively in our Cardiology department during 01.01- 31.12.2013. The final diagnosis was established by clinic, biologic and echocardiographic data and vital status at discharge was collected. This data were analysed according to clinical form and in hospital mortality.

Results: Ninty two patients with APE non ACS and 136 patients with CDAHF IVNYHA Class. Similar average age for both forms (73.32 years). A slightly higher percentage of men for CDAHF (55.88%) and women for APE (54.35%), difference with no statistical value (p=0.9). Hypertension, type II diabetes and dyslipidemias are the most identified risk factor, with a higher percentage for APE vs CDAHF with statistical value (p<0.05). The ischemic etiology predominates in both clinical forms. There are statistically significant (SS) differences for pretherapeutic Systolic Blood Presure (SBP) and clinical form (p<0.001) with higher average values for APE vs CDAHF, with no significant correlation to IHM for SBP in APE (p=0.9), significant for CDAHF (p<0.001). There are no statistical differences between adminission heart rate and clinical form, neither correlations of this with IHM. There are SS correlations between Urea (p<0.001), Creatinine (p=0.07) and on admission sodium (p=0.004) with IHM for CDAHF, for APE just for sodium (p<0.001). There are o lot of echo parameters correlated with IHM for both APE and CDAHF, the values of these parameters change according to clinical form and etiology.

Conclusions: Clinically different on admission, APE nonACS and CDAHF present as much common elements as particular ones. The ischemic etiology is a common cause, with more cardiovascular risk factors and a cumulation of them for APE. Classic parameters: on admission SBP, Urea, Creatinine, Sodium maintain a positive prognostic value for IHM just in CDAHF patients, for APE patients echocardiographic parameters have proven prognostic value, and less clinical and biological ones.

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