Incremental Value of systolic time intervals combined to clinical scores in the assessment of 30-day risk of death and hospital readmission in acute heart failure

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Incremental Value of systolic time intervals combined to clinical scores in the assessment of 30-day risk of death and hospital readmission in acute heart failure

Authors: Nousseiba Azaeiez, Ben Marzouk Maryem, Beltaief Kaouthar, Msolli Mohamed Amine, Boubaker Hamdi, Grissa Mohamed Habib, Zorgati Asma, Methemem Mehdi, Boukef Riadh, Belguith Asma, Bouida Wahid, Nouira Semir

Establishments: Emergency Department, FattoumaBourguiba University Hospital, Emergency Department, Sahloul University Hospital, Department of Preventive Medicine, Fattouma Bourguiba University Hospital, Research Laboratory LR12SP18 University of Monastir, Department of Emergency Medicine, Farhat Hached University Hospital

BACKGROUND : Acute heart failure (AHF) is a leading cause of hospitalization and death. Prediction ofv these adverse events is still challenging. The aim of our study is to demonstrate whether systolic time intervals (STIs) can improve clinical scores for predicting 30-day mortality and readmission in patients with acute decompensated heart failure (ADHF) in the ED.

METHODS : !is is a prospective study including 642 patients with ADHF aged more than 18 years. In all included patients demographic and clinical data were collected and the EFFECT (Enhanced Feedback for E"ective Cardiac Treatment) and GWTG-HF (Get With the Guidelines-Heart Failure) scores were calculated. We also measured baseline brain natriuretic peptide and STIs using acoustic cardiographic. STIs included the electromechanical activation time (EMAT), left ventricular ejection time (LVET) and systolic time ratio (STR). A 30-day follow-up was performed to record death and hospital readmission. !e performance of STIs and clinical scores alone and their combination to predict 30-day outcome was assessed in the overall population and in the subgroups of patients with preserved and reduced left ventricular ejection fraction (LVEF).

RESULTS : !e value of the EFFECT score in predicting one-month combined events (death and or readmission) was better than the GWTG-HF score with respectively an area under ROC curve of 0.67 [95% CI 0.60-0.73] and 0.56 [95% CI0.50-0.62] (p=…..). !e highest area under ROC curve was found with STR (AUC= 0.79 [95% CI 0.74-0.83] vs 0.73 [95% CI 0.68-0.78] and 0.68 [95% CI 0.63-0.73] respectively for EMAT and LVET). Discrimination power of all STIs was greater in patients with reduced LVEF. !e combination of STR to the EFFECT score improved the area under ROC curve from 0.67 to 0.74 (p=0.02) and when combined to the GWTGHF, the STR improved the area under ROC curve 0.56 to 0.64 (p=0.04).

CONCLUSION : Evaluation of STIs may add an incremental short term prognostic information to clinical scores such as EFFECT and GW-HF in patients with ADHF. !ese easily acquired parameters could assists in stratifying cardio-vascular risk in this group of patients.