Are de novo acute heart failure and acutely worsened chronic heart failure two subgroups of the same syndrome?

Abstract

Introduction: Acute heart failure (AHF) is one of the most common diseases in emergency medicine, associated with poor prognosis and high in-hospital and long-term mortality. Objective: To investigate clinical presentation of patients with de novo AHF and acute worsening of chronic heart failure (CHF) and to identify differences in blood levels of biomarkers and echocardiography findings. Methods: This prospective study comprised 64 consecutive patients being grouped according to the onset of the disease into patients with the de novo AHF (45.3%), and patients with acute worsening of CHF (54.7%). Results: Acute congestion (60%) was the most common manifestation of de novo AHF, whereas pulmonary oedema (43.1%) was the most common manifestation of acutely decompensated CHF. Patients with acutely decompensated CHF had significantly higher blood values of creatinine (147.10 vs 113.16 μmol/l; p<0.05), urea (12.63 vs 7.82 mmol/l; p<0.05), BNP (1440.11 vs 712.24 pg/ml; p<001) and NTproBNP (9097.00 vs 2827.70 pg/ml; p<0.01) on admission, and lower values of M-mode left ventricular ejection fraction (LVEF) during hospitalization (49.44% vs 42.94%; p<0.05). The follow-up after one year revealed still significantly higher BNP (365.49 vs 164.02 pg/ ml; p<0.05) and lower average values of both LVEF in patients with acutely worsened CHF (46.62% vs 54.41% and 39.52% vs 47.88%; p<0.05). Conclusion: Considering differences in clinical severity on admission, echocardiography and natriuretic peptide values during hospitalization and after one year follow-up, de novo AHF and acutely worsened CHF are two different subgroups of the same syndrome.