Abstract 15101: Does Echocardiography Provide Additional Insight Into Outcome in Patients Admitted With Acute Respiratory Decompensation?
Background: Hospitalization for decompensated lung disease is known to portend a poor prognosis. Scoring systems can predict clinical outcome, though few have included cardiac features. Whether echo provides additional prognostic benefit is unknown.
Methods: We manually reviewed the electronic medical records of patients admitted with acute respiratory failure to a special pulmonary recovery unit. We examined demographic characteristics and echos performed during hospitalization. When available we also reviewed echos prior to admission. All death certificates were reviewed, as were the discharge summaries.
Results: Among 327 patients only 241 (74%) survived to discharge. Survivors were similar to descendents with respect to age (64 years), sex (42% vs. 49%), obstructive lung disease (70 vs. 61%), diabetes (41% vs. 51%) and coronary disease (33% vs. 25%). Patients who died had more chronic kidney disease (35% vs. 19%, p=0.007), lower albumin (3.2±0.7 vs. 3.0±0.7, p=0.018), lower sodium (136±7 vs. 139±5, p=0.003) and higher serum lactate (2.4±2.0 vs. 1.5±1.4, p=0.001). Interestingly there were no differences in left ventricular size, function or valve disease based on survival. Similarly right ventricular size and function were not different, and right ventricular systolic pressure was comparable. Right atrial dilatation was present in 11% of descendents, compared with 28% of survivors (p=0.007); similarly right atrial pressure was lower in descendents (6.0±3.6 vs. 7.1±3.9, p=0.013). Renal function worsened more frequently in descendents (p=0.005), suggesting possible prerenal azotemia. Different multivariable models each demonstrated right atrial dilatation as the most potent predictor of outcome. Interestingly on the prior echo no difference was seen in right atrial dilatation (35% vs. 34%), again suggesting transient volume depletion.
Conclusions: In patients admitted with respiratory decompensation, mortality is high (>25%). Echo provides independent prognostic information, surprisingly not related to pulmonary pressure or biventricular size and function, but by presence of right atrial enlargement. The latter appears protective, suggesting an important role for properly maintaining volume status in these patients.
Author Disclosures: D. Gumber: None. V. Sanghi: None. L. Young: None. M. Zdradzinski: None. M. Sasidhar: None. R.A. Krasuski: Honoraria; Modest; Roche. Consultant/Advisory Board; Modest; Actelion, Bayer.
- © 2015 by American Heart Association, Inc.