Aurora Lindsey, Gorgis Sarah, Gandolfo Chaun, Sadiq Omar, Gakhal Gurinder, Jacobsen Gordon, Ananthasubramaniam Karthik
Heart & Vascular Institute, Henry Ford Hospital Detroit, Henry Ford West Bloomfield Hospital 5, West Bloomfield, MI, USA.
Department of Gastroenterology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Int J Cardiovasc Imaging. 2025 Sep 3. doi: 10.1007/s10554-025-03498-4.
Transthoracic echocardiography (TTE) at the time of acute decompensated heart failure (ADHF) may reveal significant structural and hemodynamic abnormalities that can guide clinical management. However, the impact of routine repeat TTE in uncomplicated ADHF re-admissions is yet to be established. We studied patients with repeat TTE at the time of rehospitalization for ADHF to determine downstream clinical impact. In a single center retrospective study, 410 adult patients with 2 ADHF admissions within 1 year were studied. 185 patients met inclusion criteria. Demographics, key echocardiography parameters and clinical changes were collected between first and second TTE. The study population comprised predominantly of Caucasians (55.7%) and males (53%). Non-ischemic cardiomyopathy was the principal etiology of heart failure. Between first and second TTE, there were no statistically significant changes noted in left ventricular ejection fraction, right ventricular systolic pressure, right atrial pressure, E/e ratio, or diastolic function. Right ventricular function was noted to significantly worsen as seen on the second TTE (p < 0.001). Mitral and aortic regurgitation was noted to be less severe in the repeat TTE group (p = 0.030 and p = 0.047, respectively). The predominant impact of repeat TTE in rehospitalized ADHF patients was medication changes rather than significant interventions, such as advanced imaging or invasive procedures. Our study demonstrates that clinicians should focus on reserving utilization of repeat TTE in uncomplicated ADHF readmissions to those not responding to standard medical optimization including diuresis. Major effect on downstream interventions and new diagnosis is not significantly impacted by repeating TTE.
急性失代偿性心力衰竭（ADHF）发作时的经胸超声心动图（TTE）可能会显示出显著的结构和血流动力学异常，这些异常可指导临床管理。然而，常规重复TTE在无并发症的ADHF再次入院中的影响尚未明确。我们研究了因ADHF再次住院时接受重复TTE检查的患者，以确定其对下游临床的影响。在一项单中心回顾性研究中，对410名在1年内有2次ADHF入院记录的成年患者进行了研究。185名患者符合纳入标准。收集了首次和第二次TTE检查之间的人口统计学数据、关键超声心动图参数和临床变化。研究人群主要为白种人（55.7%）和男性（53%）。非缺血性心肌病是心力衰竭的主要病因。在首次和第二次TTE检查之间，左心室射血分数、右心室收缩压、右心房压力、E/e比值或舒张功能均未发现有统计学意义的变化。第二次TTE检查显示右心室功能显著恶化（p<0.001）。重复TTE检查组的二尖瓣和主动脉瓣反流程度较轻（分别为p=0.030和p=0.047）。重复TTE检查对再次住院的ADHF患者的主要影响是药物治疗的改变，而非重大干预措施，如高级影像学检查或侵入性操作。我们的研究表明，临床医生应将重复TTE检查的使用保留给那些对包括利尿在内的标准药物优化治疗无反应的无并发症ADHF再次入院患者。重复TTE检查对下游干预措施和新诊断的主要影响并不显著。
