Structural Heart Failure As A Distinct Group In Acute Decompensated Heart Failure

Introduction As promising percutaneous interventions for significant (i.e. more than moderate) mitral and tricuspid regurgitation (MR and TR, respectively) are becoming available, patients with heart failure (HF) and these lesion represent a group which can derive much benefit from their appropriate use. We defined a new category of HF - advanced structural HF (ASHF), with the purpose of focusing on these 2 categories. Methods ASHF was defined as the presence of significant TR or MR with LVEF lower than 50%. Patients admitted with acute decompensated HF (ADHF) and ASHF were prospectively enrolled. A standardized diuretic protocol was employed when indicated, and appropriate GDMT as well as outpatient follow-up by a HF specialist were scheduled prior to discharge, Figure 1. We then compared characteristics and outcomes of these patients to all ADHF patients admitted to our center. Results Over 6 months, 591 patients were admitted with ADHF, 82 (14%) of these had ASHF. For ASHF patients, mean age was 65±13, 42 (51%) were males, median LVEF was 30% [20-53], and median B-type natriuretic peptide level was 1821pg/nL [847-2786], Figure 2. Patients with ASHF had lower blood pressure, creatinine clearance and LVEF, and were less likely to have COPD and ischemic cardiomyopathy. The diuretic protocol was initiated in 63 (77%) ASHF patients, 58 (92%) had adequate response (i.e. more than 100cc/h for at least 6 hours). Patients admitted with ASHF had a longer hospital stay than ADHF only patients (8 [5-13] vs. 6 [4-12] days, p=0.018). Thirty-day HF re-hospitalization rate and survival were similar. In 8 (72%) patients with baseline significant MR who completed follow-up echocardiography, MR severity improved to moderate or less. Similarly, in 8 (44%) patients, TR severity improved to moderate or less. Conclusion Significant MR and TR are common in ADHF. Aggressive diuretic therapy was successful, but hospital stay for ADHF was still longer for ASHF patients. Persistent significant leakage on follow-up was evident in 30-50%.