Prognostic implication of physical signs of congestion in acute heart failure patients and its association with steady-state biomarker levels

Sayoko Negi, Mitsuaki Sawano, Shun Kosaka, Taku Inohara, Yasuyuki Shiraishi, Takashi Kohno, Yuichiro Maekawa, Motoaki Sano, Tsutomu Yoshikawa, Keiichi Fukuda

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Congestive physical findings such as pulmonary rales and third heart sound (S3) are hallmarks of acute heart failure (AHF). However, their role in outcome prediction remains unclear. We sought to investigate the association between congestive physical findings upon admission, steady-state biomarkers at the time of discharge, and long-term outcomes in AHF patients. Methods: We analyzed the data of 133 consecutive AHF patients with an established diagnosis of ischemic or non-ischemic (dilated or hypertrophic) cardiomyopathy, admitted to a single-center university hospital between 2006 and 2010. The treating physician prospectively recorded major symptoms and congestive physical findings of AHF: paroxysmal nocturnal dyspnea, orthopnea, pulmonary rales, jugular venous distension (JVD), S3, and edema. The primary endpoint was defined as rehospitalization for HF. Results: Majority (63.9%) of the patients had non-ischemic etiology and, at the time of admission, S3 was seen in 69.9% of the patients, JVD in 54.1%, and pulmonary rales in 43.6%. The mean follow-up period was 726 ± 31days. Patients with pulmonary rales (p < 0.001) and S3 (p = 0.011) had worse readmission rates than those without these findings; the presence of these findings was also associated with elevated troponin T (TnT) levels at the time of discharge (odds ratio [OR] 2.8; p = 0.02 and OR 2.6; p = 0.05, respectively). Conclusion: Pulmonary rales and S3 were associated with inferior readmission rates and elevated TnT levels on discharge. The worsening of the readmission rate owing to congestive physical findings may be a consequence of on-going myocardial injury.

Original languageEnglish
Article numbere96325
JournalPLoS One
Volume9
Issue number5
DOIs
Publication statusPublished - 2014 May 6

Fingerprint

Respiratory Sounds
Biomarkers
heart failure
biomarkers
Heart Failure
lungs
Association reactions
Lung
troponin T
Troponin T
odds ratio
neck
Paroxysmal Dyspnea
Neck
heart sounds
Odds Ratio
Heart Sounds
Hypertrophic Cardiomyopathy
cardiomyopathy
dyspnea

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Prognostic implication of physical signs of congestion in acute heart failure patients and its association with steady-state biomarker levels. / Negi, Sayoko; Sawano, Mitsuaki; Kosaka, Shun; Inohara, Taku; Shiraishi, Yasuyuki; Kohno, Takashi; Maekawa, Yuichiro; Sano, Motoaki; Yoshikawa, Tsutomu; Fukuda, Keiichi.

In: PLoS One, Vol. 9, No. 5, e96325, 06.05.2014.

Research output: Contribution to journalArticle

@article{45484897027646419e761488273b7621,
title = "Prognostic implication of physical signs of congestion in acute heart failure patients and its association with steady-state biomarker levels",
abstract = "Background: Congestive physical findings such as pulmonary rales and third heart sound (S3) are hallmarks of acute heart failure (AHF). However, their role in outcome prediction remains unclear. We sought to investigate the association between congestive physical findings upon admission, steady-state biomarkers at the time of discharge, and long-term outcomes in AHF patients. Methods: We analyzed the data of 133 consecutive AHF patients with an established diagnosis of ischemic or non-ischemic (dilated or hypertrophic) cardiomyopathy, admitted to a single-center university hospital between 2006 and 2010. The treating physician prospectively recorded major symptoms and congestive physical findings of AHF: paroxysmal nocturnal dyspnea, orthopnea, pulmonary rales, jugular venous distension (JVD), S3, and edema. The primary endpoint was defined as rehospitalization for HF. Results: Majority (63.9{\%}) of the patients had non-ischemic etiology and, at the time of admission, S3 was seen in 69.9{\%} of the patients, JVD in 54.1{\%}, and pulmonary rales in 43.6{\%}. The mean follow-up period was 726 ± 31days. Patients with pulmonary rales (p < 0.001) and S3 (p = 0.011) had worse readmission rates than those without these findings; the presence of these findings was also associated with elevated troponin T (TnT) levels at the time of discharge (odds ratio [OR] 2.8; p = 0.02 and OR 2.6; p = 0.05, respectively). Conclusion: Pulmonary rales and S3 were associated with inferior readmission rates and elevated TnT levels on discharge. The worsening of the readmission rate owing to congestive physical findings may be a consequence of on-going myocardial injury.",
author = "Sayoko Negi and Mitsuaki Sawano and Shun Kosaka and Taku Inohara and Yasuyuki Shiraishi and Takashi Kohno and Yuichiro Maekawa and Motoaki Sano and Tsutomu Yoshikawa and Keiichi Fukuda",
year = "2014",
month = "5",
day = "6",
doi = "10.1371/journal.pone.0096325",
language = "English",
volume = "9",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "5",

}

TY - JOUR

T1 - Prognostic implication of physical signs of congestion in acute heart failure patients and its association with steady-state biomarker levels

AU - Negi, Sayoko

AU - Sawano, Mitsuaki

AU - Kosaka, Shun

AU - Inohara, Taku

AU - Shiraishi, Yasuyuki

AU - Kohno, Takashi

AU - Maekawa, Yuichiro

AU - Sano, Motoaki

AU - Yoshikawa, Tsutomu

AU - Fukuda, Keiichi

PY - 2014/5/6

Y1 - 2014/5/6

N2 - Background: Congestive physical findings such as pulmonary rales and third heart sound (S3) are hallmarks of acute heart failure (AHF). However, their role in outcome prediction remains unclear. We sought to investigate the association between congestive physical findings upon admission, steady-state biomarkers at the time of discharge, and long-term outcomes in AHF patients. Methods: We analyzed the data of 133 consecutive AHF patients with an established diagnosis of ischemic or non-ischemic (dilated or hypertrophic) cardiomyopathy, admitted to a single-center university hospital between 2006 and 2010. The treating physician prospectively recorded major symptoms and congestive physical findings of AHF: paroxysmal nocturnal dyspnea, orthopnea, pulmonary rales, jugular venous distension (JVD), S3, and edema. The primary endpoint was defined as rehospitalization for HF. Results: Majority (63.9%) of the patients had non-ischemic etiology and, at the time of admission, S3 was seen in 69.9% of the patients, JVD in 54.1%, and pulmonary rales in 43.6%. The mean follow-up period was 726 ± 31days. Patients with pulmonary rales (p < 0.001) and S3 (p = 0.011) had worse readmission rates than those without these findings; the presence of these findings was also associated with elevated troponin T (TnT) levels at the time of discharge (odds ratio [OR] 2.8; p = 0.02 and OR 2.6; p = 0.05, respectively). Conclusion: Pulmonary rales and S3 were associated with inferior readmission rates and elevated TnT levels on discharge. The worsening of the readmission rate owing to congestive physical findings may be a consequence of on-going myocardial injury.

AB - Background: Congestive physical findings such as pulmonary rales and third heart sound (S3) are hallmarks of acute heart failure (AHF). However, their role in outcome prediction remains unclear. We sought to investigate the association between congestive physical findings upon admission, steady-state biomarkers at the time of discharge, and long-term outcomes in AHF patients. Methods: We analyzed the data of 133 consecutive AHF patients with an established diagnosis of ischemic or non-ischemic (dilated or hypertrophic) cardiomyopathy, admitted to a single-center university hospital between 2006 and 2010. The treating physician prospectively recorded major symptoms and congestive physical findings of AHF: paroxysmal nocturnal dyspnea, orthopnea, pulmonary rales, jugular venous distension (JVD), S3, and edema. The primary endpoint was defined as rehospitalization for HF. Results: Majority (63.9%) of the patients had non-ischemic etiology and, at the time of admission, S3 was seen in 69.9% of the patients, JVD in 54.1%, and pulmonary rales in 43.6%. The mean follow-up period was 726 ± 31days. Patients with pulmonary rales (p < 0.001) and S3 (p = 0.011) had worse readmission rates than those without these findings; the presence of these findings was also associated with elevated troponin T (TnT) levels at the time of discharge (odds ratio [OR] 2.8; p = 0.02 and OR 2.6; p = 0.05, respectively). Conclusion: Pulmonary rales and S3 were associated with inferior readmission rates and elevated TnT levels on discharge. The worsening of the readmission rate owing to congestive physical findings may be a consequence of on-going myocardial injury.

UR - http://www.scopus.com/inward/record.url?scp=84900441423&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84900441423&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0096325

DO - 10.1371/journal.pone.0096325

M3 - Article

VL - 9

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 5

M1 - e96325

ER -