Prognostic Value of Transthoracic Impedance Cardiography, Amino-Terminal Pro-B-Type Natriuretic Peptide Levels, The Six-Minute Walk Test, and Chest X-Ray in Elderly Patients with Chronic Heart Failure: A Comparative Study in Lithuania.

BACKGROUND Chronic heart failure (CHF) is a complex clinical syndrome associated with frequent, recurrent, and long-term hospitalizations. This study from a single center in Lithuania aimed to evaluate outcomes in 87 elderly patients hospitalized with CHF. The methods used included comparing transthoracic impedance cardiography (ICG), amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, the six-minute walk test (6MWT), and dilatation of the right pulmonary artery on chest X-ray (dRPAcXR). MATERIAL AND METHODS The study sample consisted of 87 patients (49 men and 38 women). All subjects underwent 6MWT and ICG in addition to the standard CHF tests. The median duration of the follow-up was 23 months. Data about patient outcomes were gathered from the National Medical Record Database. RESULTS By multivariate Cox proportional analysis, thoracic fluid content (TFC) ≥41.1 1/kΩ (hazard ratio [HR] 32.354, 95% confidence interval [CI] 2.758-379.488), NT-proBNP ≥332.0 pmol/L (HR 4.739, 95% CI 1.656-13.559), 6-minute walk distance (6MWD) ≤203.5 m (HR 3.975, 95% CI 1.002-15.770), and dRPAcXR (HR 5.555, 95% CI 1.714-18.005) were associated with a poor prognosis in CHF patients (all P<0.05). The correlations between ICG and 6MWD and other non-invasive diagnostic tests examined in this study were weak to moderate. CONCLUSIONS TFC ≥41.1 1/kΩ, NT-proBNP ≥332.0 pmol/L, 6MWD ≤203.5 m, and dRPAcXR had a combined prognostic value in predicting cardiovascular death in patients with CHF. Therefore, these parameters may be of value in the assessment of the diagnosis and prognosis in this patient cohort.

Early repolarization pattern on ECG predicts worse outcomes in patients hospitalized due to chronic heart failure decompensation.

BACKGROUND: To improve the outcomes of patients with chronic heart failure (CHF), it is important to identify reliable prognostic tools. Early repolarization pattern (ER) on 12­lead electrocardiogram (ECG) is a predictor of worse outcomes, which has been widely researched in the general population but not in the CHF population. OBJECTIVE: To evaluate the incidence and prognostic value of ER and compare its prognostic significance with other non-invasive diagnostic methods for CHF outcomes and hospital readmissions. METHODS: The study included 301 patients (166 men and 135 women) hospitalized for CHF decompensation. CHF diagnosis was confirmed according to the current guidelines. The patients underwent standard tests and impedance cardiography (ICG) at enrollment and on the day of discharge. RESULTS: Thirty-one confirmed ER cases (10.3%) were enrolled. During a median follow-up period of 18 months, 128 cardiac-related deaths were observed (42.5%), with 23 (74.2%) and 105 (38.9%) patients in the ER and non-ER groups, respectively (p < 0.001). The ER group had more readmissions than the non-ER group did at 6-months (2 [1, 2] vs. 1 [1, 2]; p=0.04) and 12-months (3 [2-4] vs. 2 [1-3]; p<0.001). ER on ECG (hazard ratio [HR] 2.59; 95% confidence interval [CI] 1.64-4.07; p<0.001), N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels ≥425.5 pmoL/L (HR 5.1; 95% CI 3.33-7.83; p < 0.001), thoracic fluid content (TFC) ≥36.9 1/kΩ (HR 4.6; 95% CI 2.7-7.85, p < 0.001), and left ventricular ejection fraction (LVEF) ≤40% (HR 4.94; 95% CI 2.83-8.65; p < 0.001) were independently and significantly associated with cardiac death. CONCLUSIONS: The combination of ER, LVEF ≤40%, NT-proBNP, or TFC provides an incremental prognostic value for cardiac-related death in patients with CHF.