Non-invasive assessment of acute heart failure by Stevenson classification: Does echocardiographic examination recognize different phenotypes?

Alberto Palazzuoli; Gaetano Ruocco; Serafina Valente; Andrea Stefanini; Erberto Carluccio; Giuseppe Ambrosio

doi:10.3389/fcvm.2022.911578

Non-invasive assessment of acute heart failure by Stevenson classification: Does echocardiographic examination recognize different phenotypes?

Front Cardiovasc Med. 2022 Sep 27:9:911578. doi: 10.3389/fcvm.2022.911578. eCollection 2022.

Authors

Alberto Palazzuoli¹, Gaetano Ruocco², Serafina Valente³, Andrea Stefanini¹, Erberto Carluccio⁴, Giuseppe Ambrosio⁴

Affiliations

¹ Cardiovascular Diseases Unit, Cardio Thoracic Department, Le Scotte Hospital, University of Siena, Siena, Italy.
² Cardiology Unit, Riuniti of Valdichiana Hospitals, USL-SUD-EST Toscana, Montepulciano, Italy.
³ Cardiology Unit, Cardio Thoracic Department, Le Scotte Hospital, University of Siena, Siena, Italy.
⁴ Division of Cardiology and Center for Clinical and Translational Research - CERICLET, University of Perugia, Perugia, Italy.

Abstract

Background: Acute heart failure (AHF) presentation is universally classified in relation to the presence or absence of congestion and the peripheral perfusion condition according to the Stevenson diagram. We sought to evaluate a relationship existing between clinical assessment and echocardiographic evaluation in patients with AHF.

Materials and methods: This is a retrospective blinded multicenter analysis assessing both clinical and echocardiographic analyses during the early hospital admission for AHF. Patients were categorized into four groups according to the Stevenson presentation: group A (warm and dry), group B (cold and dry), group C (warm and wet), and group D (cold and wet). Echocardiographic evaluation was executed within 12 h from the first clinical evaluation. The following parameters were measured: left ventricular (LV) volumes, LV ejection fraction (LVEF); pattern Doppler by E/e1 ratio, pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE), and inferior cave vein diameter (ICV).

Results: We studied 208 patients, 10 in group A, 16 in group B, 153 in group C, and 29 in group D. Median age of our sample was 81 [69-86] years and the patients enrolled were mainly men (66.8%). Patients in groups C and A showed significant higher levels of systolic arterial pressures with respect to groups B and D (respectively, 130 [115-145] mmHg vs. 122 [119-130] mmHg vs. 92 [90-100] mmHg vs. 95 [90-100] mmHg, p < 0.001). Patients in groups A and C (warm) demonstrated significant higher values of LVEF with respect to patients in groups B and D (43 [34-49] vs. 42 [30-49] vs. 27 [15-31] vs. 30 [22-42]%, p < 0.001). Whereas group B experienced significant lower TAPSE values compared with other group (14 [12-17] mm vs. A: 17 [16-21] mm vs. C: 18 [14-20] mm vs. D: 16 [12-17] mm; p = 0.02). Finally, echocardiographic congestion score including PASP ≥ 40 mmHg, ICV ≥ 21, mm and E/e' > 14 did not differ among groups. Follow-up analysis showed an increased mortality rate in D group (HR 8.2 p < 0.04).

Conclusion: The early Stevenson classification remains a simple and universally recognized approach for the detection of congestion and perfusion status. The combined clinical and echocardiographic assessment may be useful to better define the patients' profile.

Keywords: Stevenson classification; acute heart failure (AHF); congestion; echocardiography; perfusion.