Introduction: Echocardiography has an important role in the management of heart failure. However, the optimal timing of echocardiographic examination is not well discussed.
Hypothesis: We hypothesized that echocardiographic parameters immediately before the discharge can provide more valuable information than parameters at admission in patients with both heart failure with reduced and preserved ejection fraction (HFrEF and HFpEF). Our aim was to assess echocardiographic parameters at admission and before discharge in HFrEF and HFpEF as predictors of readmission.
Methods: We enrolled 218 hospitalized HF patients who underwent echocardiographic studies within 2 days of admission and within 5 days of discharge. Patients were divided into HFrEF (EF<45%, n=126) and HFpEF (EF ≥45%, n=92). The primary endpoint was hospital readmission for HF.
Results: There were 48 hospital readmission during 25±16 months of follow-up. On admission, only systolic pulmonary artery pressure (SPAP) was modestly associated with event-free survival after adjustment for age, gender, estimated glomerular filtration rate, and ejection fraction in a Cox proportional-hazards model (hazard ratio, 1.02: p =0.043). Before discharge, E/e’ (hazard ratio, 1.02: p =0.044) and SPAP (hazard ratio, 1.03: p =0.007) were strongly associated with event-free survival after adjustment for age, gender, estimated glomerular filtration rate, and ejection fraction in both HFrEF and HFpEF (Figure: Kaplan-Meier analysis of time-to-event in HFrEF and HFpEF patients stratified according to optimal cut off values of E/e’ and SPAP).
Conclusions: Echocardiographic study before discharge provides more conventional parameter information in both HF phenotypes. Optimal echocardiographic timing should be considered for the management of HF.