Hemodynamic profiling with impedance cardiography in patients with heart failure and reduced ejection fraction improves clinical outcomes

• Published in: Archives of cardiovascular diseases Vol. 117; no. 1; p. S47
• Main Authors: Charfeddine, S., Jarraya, M., Gargouri, R., Gargouri, H., Jabeur, M., Triki, F., Hammami, R., Ellouze, T., Bahloul, A., Abid, L.
• Format: Journal Article
• Language: English
• Published: Elsevier Masson SAS 01.01.2024
• ISSN: 1875-2136
• DOI: 10.1016/j.acvd.2023.10.084

Heart failure with reduced ejection fraction (HFrEF) is still associated to a high rate of mortality and re-hospitalization. New HF therapy such as SGLT2 inhibitors (SGLT2i) and sacubitril valsaratan (ARNI) had proven to be effective in reducing morbidity and mortality. But the effect of these therapies on echographic and haemodynamic parameters measured by impedance cardiography (ICG) data is still controversial. To evaluate the impact of HF treatment guided by ICG haemodynamic study at 6-months rehospitalization and mortality. A prospective monocentric study (with a case control group) conducted between June 2021 and November 2022. Patients included had left ventricle ejection fraction (LVEF ≤ 40%), a creatinine clearance > 30mL/min and no other severe pathology that could alter the prognosis. All patients had echocardiographic and hemodynamic study with a follow-up at 6 months. A total of 127 patients with HFrEF were included. The mean LVEF of our patients increased from 26% to 29% and LV filling pressures were elevated in 22.7% at inclusion and 13.2% at 6-months follow up. The 6-month rehospitalization and death rates were 22.8% and 18.1% respectively. The ARNI/SGLT2i group had significantly lower rates of rehospitalization and death from cardiovascular causes with P=0.001 and P=0.015 respectively. In the multivariate study, tachycardia, renal failure and elevated resistance measured by ICG were independent factors associated with mortality (OR=6.56, P=0.05; OR=13.457, P=0.03 and OR=10.354, P=0.03 respectively) while reduced intra thoracic fluid and optimal medical therapy were protective factors (OR=0.866, P=0.002 and OR=0.035, P=0.03 respectively). A controlled volemia collected by ICG and gliflozin treatment were independent protective factors of re-hospitalization in multivariate study (OR=0.257, P=0.02 and OR=0,239, P=0.02 respectively). The HFrEF is still a disease with a poor prognosis. Hemodynamic parameters measured by impedance cardiography could improve the disease profiling and patients’ management in the era of new therapies.