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Lung injury, a clinical issue among patients with acute heart failure?

Session Poster Session 3

Speaker Ioan Radu Lala

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure – Epidemiology, Prognosis, Outcome
  • Session type : Poster Session

Authors : IR Lala (Arad,RO), DA Darabantiu (Arad,RO), A Pop-Moldovan (Arad,RO), M Puschita (Arad,RO)

Authors:
IR Lala1 , DA Darabantiu1 , A Pop-Moldovan1 , M Puschita1 , 1Vasile Goldis Western University, Cardiology - Arad - Romania ,

Citation:

Background: Pulmonary congestion in acute heart failure (AHF) is by far a much more complex phenomenon, beyond that of fluid overload. It has been pointed out the role of inflammation and lung injury that leads to blood-gas barrier dysfunction in cardiogenic pulmonary edema.

Purpose: To evaluate incidence and prognostic implications of lung injury (LI) at admission in AHF patients.

Methods: In this study we have evaluated 114 consecutive patients from our regional heart failure registry, with a primary diagnosis of AHF admitted in the intensive care unit. PaO2/FiO2 ratio was determined to all patients. Patients were divided into two groups: group 1 with a PaO2/FiO2 ratio < 200 mmHg and group 2 with a ratio > 200 mmHg. For statistical analysis we used independent t test for comparison of continuous values, Pearson x ² test for comparison of categorical values, multivariate logistic regression, survival curves and Cox regression for predictors of in-hospital mortality.

Results: Mean age was 68 ± 58 years and 49% were female regardless of LI development. The percentage of patients with LI was 72%, with a mean of 233±119mmHg. Group 1 was associated with acute pulmonary edema AHF profile (28%, p=0.002) while group 2 was associated with acute decompensated heart failure AHF profile (26%, p=0.001). Patients with cardiogenic shock profile were more frequent seen in group 1 (10% vs 6%, p=0.6) while patients with right heart failure profile were seen more frequent in group 2 (5.3% vs. 4.4%, p=0.5). A PaO2/FiO2 < 200mmHg was correlated with respiratory acidosis (pH=7.3, pCO2=46 mmol/L, p=0.022).  Patients with a PaO2/FiO2 < 200 mmHg had a significantly worse survival profile during hospitalization (log-rank test, p<0.045) and Cox proportional hazards modelling showed a crude HR = 1.7 (95%CI [1-3.2], p<0.05) for in-hospital mortality.

Conclusions: There is a high incidence of lung injury within patients admitted for acute heart failure. Patients with acute pulmonary edema are more prone to develop lung injury. A PaO2/FiO2 ratio < 200 mmHg at admission in patients with AHF is responsible for worse in-hospital survival rates. Even though PaO2/FiO2 ratio is used to define acute respiratory distress syndrome among critically ill patients it might also serve as a useful tool in stratifying risk of patients with AHF. Future larger prospective trials are needed.

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