Predictores de descompensación y mortalidad en los tres escenarios de la insuficiencia cardíaca: aguda, crónica y fase vulnerable
Introduction: Heart Failure (HF) is a disease whose course is characterized by episodes of exacerbation or decompensation that progressively deteriorate the patient's condition. There are well identified precipitating factors, but in many cases, we do not know what the trigger is. Faced with th...
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| Tipo de recurso: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2024 |
| País: | España |
| Institución: | Universidad de Valladolid |
| Repositorio: | UVaDOC. Repositorio Documental de la Universidad de Valladolid |
| OAI Identifier: | oai:uvadoc.uva.es:10324/66292 |
| Acceso en línea: | https://doi.org/10.35376/10324/66292 https://uvadoc.uva.es/handle/10324/66292 |
| Access Level: | acceso abierto |
| Palabra clave: | Insuficiencia cardíaca Heart failure Insuficiencia cardiaca Atrial fibrillation Fibrilación auricular 32 Ciencias Médicas |
| Sumario: | Introduction: Heart Failure (HF) is a disease whose course is characterized by episodes of exacerbation or decompensation that progressively deteriorate the patient's condition. There are well identified precipitating factors, but in many cases, we do not know what the trigger is. Faced with this problem, our objective was to determine which parameters collected from the patient's clinical history or from complementary tests may be associated with decompensation in HF. Methods: Three clinical scenarios with different risk profiles were initially identified: chronic HF, acute HF, and the period around HF exacerbation which has been described as the vulnerable phase. Medical history, clinical and analytical data including new biomarkers, and echocardiographic parameters were collected. Functional assessment tests were performed, and frailty and the presence of comorbid conditions in each patient were evaluated. The score of two predictive models in HF was calculated. The endpoints were HF decompensation defined as an admission, an emergency department visit or an outpatient episode, and mortality. Results: 393 patients were included. The longest follow-up period was 4.6 ± 2.7 years in the group of patients followed in the HF clinic. In this sample of patients with chronic HF, the Kansas City Cardiomyopathy Questionnaire quality of life test, the 6-minute walk test, the BCN-Bio-HF and the MAGGIC-HF risk prediction models showed association with decompensation and mortality. In addition, the values of five biomarkers involved in different pathophysiological pathways of HF (sST2, hsTnT, H-FABP, Gal-3 and GDF-15) were analyzed and it was shown that previous HF burden and comorbidity were important determinants of patient outcomes. In the cohort of patients hospitalized with acute HF, the patient's functional status assessed by Barthel index and frailty were associated with HF readmissions and mortality. In the sample of patients attended in the emergency department with HF, soluble ST2 levels at the time of presentation were found to be more effective than natriuretic peptide in predicting mortality. The BCN-Bio-HF calculator, developed from a sample of patients with chronic HF, demonstrated its utility as a risk score in long-term prediction after an urgent visit for HF. Conclusions: Patient functional assessment, detection of frailty, quantification of comorbidity and risk estimation through predictive models should be implemented as decision support in clinical practice in the evaluation of HF patients. sST2 concentrations demonstrated better predictive capability for early and late mortality compared to natriuretic peptides after en urgent HF visit. |
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