Echocardiographic correlates of dyspnoea during acute decompensated heart failure treatment

Introduction
Dyspnoea is frequent complaint reported by acute decompensated heart failure (ADHF) patients.

Aim of the research
To evaluate the association of dyspnoea intensity and resolution measured by the dyspnoea visual analogue scale (VAS) with structural and functional parameters obtained by echocardiography during ADHF treatment.

Material and methods
In 34 consecutive adult patients who required hospitalization due to ADHF, echocardiographic assessment was performed upon admission and at discharge, together with clinical and laboratory evaluation. The severity of dyspnoea was assessed with standardized 0–100 points VAS.

Results
At admission, in significant dyspnoea patients (VAS > 50 pts) as compared with non-significant dyspnoea (VAS < 50 pts), the right heart was more dilated and dysfunctional, mitral regurgitation was more advanced (right atrial area (RAA) 31.5 ±7.6 vs. 28.3 ±8.4 cm², p = 0.04; right ventricular outflow tract diameter 38.7 ±5.0 vs. 35.9 ±4.0 mm, p = 0.01; tricuspid annular plane systolic excursion 16.8 ±3.0 vs. 14.6 ±3.9 mm, p = 0.008; inferior vena cava 30.1 ±3.8 vs. 26.5 ±4.6 mm, p < 0.001; tricuspid regurgitation vena contracta width (VC) 6.7 ±2.0 vs. 4.7 ±2.1 mm, p < 0.001; mitral regurgitation VC 6.0 ±1.1 vs. 5.0 ±1.4 mm, p < 0.006). The admission dyspnoea score was not associated with left heart structure or left ventricular ejection fraction. In patients with significant dyspnoea reduction during treatment (VAS ≥ 30 pts), but not in patients with weak dyspnoea reduction (VAS ≤ 20 pts), significant decreases of RAA (30.9 ±5.1 vs. 25.7 ±4.9 cm², p < 0.001), tricuspid regurgitation peak gradient (45.9 ±11.0 vs. 34.9 ±6.9 mm Hg, p < 0.001), and mitral E/E’ (25 ±7.6 vs. 20.6 ±4.8, p = 0.01) were observed.

Conclusions
Dyspnoea severity in ADHF patients is determined mainly by mitral regurgitation severity and right heart structure and function, whereas a dyspnoea decrease during treatment is associated mainly with the reduction of left ventricular filling pressure and right ventricular systolic pressure.