TABLE 1.
Baseline characteristics of registered patients with one or recurrent episodes of acute heart failure requiring hospitalization.
| Stable patients (n = 232) |
Patients with one HF hospitalization† (n = 80) |
Patients with recurrent HF hospitalizations† (n = 110) |
P-value‡ |
P-value 1 vs > 1 HF hospitalizations$ |
|
| Clinical parameters | |||||
| Age, years (IQR) | 73 (72–74) | 75 (71–76) | 73 (72–75) | 0.613 | 0.637 |
| Female gender, n (%) | 168 (72.4) | 59 (73.8) | 70 (63.6) | 0.192 | 0.140 |
| Body mass index (kg/m2) (IQR) | 28 (25–30) | 29 (29–31) | 30 (29–32) | 0.032 | 0.216 |
| 6-minute walk distance (m) (IQR) | 380 (360–406) | 320 (306–365) | 289 (250–311) | <0.001 | 0.027 |
| NYHA functional class ≥ III, n (%) | 113 (49.8) | 51 (66.2) | 88 (82.2) | <0.001 | 0.013 |
| NT-proBNP (pg/ml) (IQR) | 770 (615–860) | 1046 (935–1210) | 1959 (1579–2184) | <0.001 | <0.001 |
| HF hospitalization prior to study inclusion, n (%) | – | 45 (56.3) | 87 (79.1) | – | 0.001 |
| Loop diuretic therapy, n (%) | 90 (39.0) | 57 (71.3) | 90 (81.8) | <0.001 | 0.086 |
| Co-morbidities | |||||
| Arterial hypertension, n (%) | 213 (92.2) | 77 (96.3) | 106 (96.4) | 0.207 | 0.967 |
| Atrial fibrillation, n (%) | 121 (52.4) | 54 (67.5) | 73 (66.4) | 0.011 | 0.870 |
| Diabetes mellitus, n (%) | 60 (26.0) | 30 (37.5) | 54 (49.1) | <0.001 | 0.112 |
| Chronic kidney disease*, n (%) | 92 (42.4) | 48 (61.5) | 76 (71.0) | <0.001 | 0.175 |
| Anemia, n (%) | 79 (34.1) | 32 (40.0) | 73 (66.4) | <0.001 | <0.001 |
| Sleep apnea, n (%) | 13 (5.6) | 3 (3.8) | 12 (10.9) | 0.096 | 0.071 |
| Chronic obstructive pulmonary disease, n (%) | 49 (21.2) | 22 (27.5) | 44 (40.0) | 0.001 | 0.074 |
| Laboratory parameters | |||||
| Hemoglobin (g/dL) (IQR) | 12.8 (11.8–13.5) | 12.6 (11.2–14.0) | 11.7 (10.8–12.8) | <0.001 | 0.005 |
| Serum iron (μg/dL) (IQR) | 77 (56–99) | 68 (52–105) | 54 (40–75) | <0.001 | 0.002 |
| Albumin (g/L) (IQR) | 41.6 (39.3–43.7) | 41.1 (38.7–43.8) | 40.3 (37.1–42.8) | 0.003 | 0.081 |
| ASAT (U/L) (IQR) | 24 (20–30) | 25 (21–32) | 23 (20–32) | 0.816 | 0.518 |
| ALAT (U/L) (IQR) | 21 (16–28) | 22 (17–28) | 19 (14–27) | 0.084 | 0.084 |
| Gamma-GT (U/L) (IQR) | 29 (19–47) | 38 (22–90) | 57 (28–88) | <0.001 | 0.104 |
| GFR (ml/min/1.73 m2) (IQR) | 64.25 (42.76–77.83) | 55.51 (40.18–67.70) | 49.83 (38.36–63.77) | <0.001 | 0.058 |
| Blood urea nitrogen (mg/dL) (IQR) | 18.95 (14.45–24.35) | 25.40 (20.10–32.75) | 25.00 (18.90–36.10) | <0.001 | 0.883 |
| HbA1c (%) (IQR) | 5.8 (5.5–6.2) | 5.9 (5.5–6.4) | 6.1 (5.6–6.9) | 0.003 | 0.175 |
| Echocardiographic parameters | |||||
| Left atrial diameter (mm) (IQR) | 60 (60–62) | 61 (60–64) | 64 (63–66) | <0.001 | 0.035 |
| Left atrial volume index (ml/m2) (IQR) | 38 (35–39) | 39 (33–44) | 40 (37–54) | 0.047 | 0.149 |
| Left ventricular end diastolic diameter (mm) (IQR) | 44 (40–47) | 43 (39–46) | 44 (40–48) | 0.312 | 0.225 |
| LV-ejection fraction (%) (IQR) | 60 (54–64) | 59 (54–65) | 60 (55–66) | 0.675 | 0.523 |
| E/E’ ratio (IQR) | 12.8 (10.4–15.3) | 13.4 (10.3–17.8) | 15.9 (9.7–18.8) | 0.202 | 0.588 |
| E/A ratio (IQR) | 1.17 (0.81–1.63) | 1.13 (0.90–2.30) | 1.90 (1.03–2.88) | 0.002 | 0.100 |
| Right atrial diameter (mm) (IQR) | 59 (53–65) | 60 (56–68) | 64 (58–70) | <0.001 | 0.018 |
| RA volume (ml) (IQR) | 57 (53–61) | 65 (51–74) | 70 (62–80) | <0.001 | 0.016 |
| Right ventricular end diastolic diameter (mm) (IQR) | 35 (31–40) | 35 (31–40) | 40 (33–44) | <0.001 | 0.002 |
| TAPSE (mm) (IQR) | 19 (15–22) | 18 (15–22) | 17 (13–20) | 0.017 | 0.180 |
| Moderate and severe tricuspid insufficiency, n (%) | 113 (50.2) | 46 (62.2) | 78 (71.6) | 0.001 | 0.182 |
| Pulmonary arterial systolic pressure (mmHg) (IQR) | 48 (37–59) | 56 (44–69) | 66 (51–79) | <0.001 | 0.001 |
| Invasive hemodynamic parameters | |||||
| Mean pulmonary arterial pressure, mmHg (IQR) | 30 (24–35) | 32 (25–39) | 38 (31–44) | <0.001 | 0.001 |
| Right atrial pressure (mmHg) (IQR) | 11 (7–13) | 11 (7–16) | 14 (10–18) | <0.001 | 0.006 |
| Pulmonary artery wedge pressure (mmHg) (IQR) | 18 (18–20) | 19 (18–21) | 22 (20–23) | <0.001 | 0.008 |
| Left ventricular end diastolic pressure (mmHg) (IQR) | 18 (17–19) | 18 (17–20) | 21 (20–23) | 0.002 | 0.005 |
NYHA, New York Heart Association; NT-proBNP, N-terminal prohormone of brain natriuretic peptide; HF, heart failure; ALAT, alanin aminotransferase; ASAT, aspartat aminotransferase; Gamma-GT, gamma-Glutamyl Transferase; GFR, glomerular filtration rate; LDH, lactatdehydrogenase; HbA1c, glycated hemoglobin; LA, left atrial; RA, right atrial; LV, left ventricular; E/E’, ratio of peak early transmitral flow velocity to peak early diastolic mitral annulus velocity; E/A, ratio of peak early transmitral flow velocity to mitral peak velocity of late filling; TAPSE, tricuspid annular plane systolic excursion. Values are given as median and interquartile range (IQR), or total numbers (n) and percent (%). Bold indicates p < 0.05.
*Estimated glomerular filtration rate <60 ml/min/1.73 m2.
†HF hospitalization was defined by the concomitant presence of the symptom of sudden-onset dyspnea and clinical signs of acute cardiac decompensation, including weight gain and fluid retention, with presence of pulmonary or peripheral edema requiring intravenous diuresis.
‡For comparisons of stable, patients with one HF hospitalization and patients with recurrent HF hospitalizations Chi-square test was used for categorical and Kruskal wallis 1-way ANOVA for continuous variables.
$For comparisons of patients with one HF hospitalization and patients with recurrent HF hospitalizations Chi-square test was used for categorical and Mann–Whitney U-test for continuous variables.