Noninvasive Hemodynamic Monitoring in Advanced Heart Failure Patients: New Approach for Target Treatments

Gianfranco Piccirillo; Federica Moscucci; Andrea Corrao; Myriam Carnovale; Ilaria Di Diego; Ilaria Lospinuso; Cristina Caltabiano; Martina Mezzadri; Pietro Rossi; Damiano Magrì

doi:10.3390/biomedicines10102407

Noninvasive Hemodynamic Monitoring in Advanced Heart Failure Patients: New Approach for Target Treatments

Biomedicines. 2022 Sep 26;10(10):2407. doi: 10.3390/biomedicines10102407.

Affiliations

¹ Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico n. 155, 00186 Rome, Italy.
² Arrhytmology Unit, Cardiology Division, S. Giovanni Calibita, Isola Tiberina, 00186 Rome, Italy.
³ Department of Clinical and Molecular Medicine, S. Andrea Hospital, "Sapienza" University of Rome, 00186 Rome, Italy.

Abstract

Using bio-impedance to deduce some hemodynamic parameters combined with some short-term ECG temporal dispersion intervals, and measuring myocardial depolarization, intraventricular conduction, and repolarization. A total of 65 in-hospital patients (M/F:35/30) were enrolled, 39 with HFrEF and 26 HFpEF, in New York Heart Association (NYHA) class IV. Stroke volume (SVI), cardiac indexes (CI), left ventricular ejection fraction (LVEFBIO), end diastolic volume (LV-EDV), and other systolic and diastolic parameters were noninvasively obtained at enrollment and at hospital discharge. At the same time, QR, QRS, QT, ST, Tpeak-Tend (Te) interval mean, and standard deviation (SD) from 5 min ECG recordings were obtained. At baseline, HFrEF patients reported significantly lower SVI (p < 0.05), CI (p < 0.05), and LVEF (p < 0.001) than HFpEF patients; moreover, HFrEF patients also showed increased LV-EDV (p < 0.05), QR, QRS, QT, ST, and Te means (p < 0.05) and standard deviations (p < 0.05) in comparison to HFpEF subjects. Multivariable logistic regression analysis reported a significant correlation between hospital mortality and Te mean (odds ratio: 1.03, 95% confidence limit: 1.01−1.06, p: 0.01). Fifty-seven percent of patients were considered responders to optimal medical therapy and, at discharge, they had significantly reduced NT-proBNP, (p < 0.001), heart rate (p < 0.05), and TeSD (p < 0.001). LVEF, obtained by transthoracic echocardiography, and LVEFBIO were significantly related (r: 0.781, p < 0.001), but these two parameters showed a low agreement limit. Noninvasive hemodynamic and ECG-derived parameters were useful to highlight the difference between HFrEF and HFpEF and between responders and nonresponders to the optimal medical therapy. Short-period bioimpedance and electrocardiographic data should be deeply evaluated to determine possible advantages in the therapeutic and prognostic approach in severe CHF.

Keywords: QT; QT variability; Tpeak-Tend; advanced heart failure; bioimpedance cardiography; mortality; temporal dispersion of repolarization phase.

Grants and funding

This research has not received any financial support by private or public institutions.