Timing on echocardiography and blood laboratory test is important for future outcome association in hospitalized heart failure patients

Background: We investigated whether both echocardiography and blood examination parameters obtained before discharge are more closely associated with adverse events than those obtained upon admission in hospitalized heart failure (HF) patients. Methods: We retrospectively selected 267 hospitalized HF patients who underwent comprehensive transthoracic echocardiography (TTE) within 2 days of admission (n = 223) and/or within 7 days of discharge (n = 157). Blood test results were also collected at the same time window. Patients were assigned into HF with reduced ejection fraction (HFrEF) and HF with preserved EF (HFpEF). Results: During a median follow-up of 12.6 months, 60 of 223 patients with admission TTE and 39 of 157 patients with pre-discharge TTE had major adverse cardiac events (MACEs) after discharge. On admission, no echocardiography parameters, but uric acid, blood urea nitrogen (BUN), creatinine, and estimated glomerular filtration rate (eGFR) were associated with MACEs in HFpEF (n = 45). In HFrEF (n = 178), vena contracta, s', BUN, eGFR, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were associated with MACEs. Before discharge, BNP, NT-proBNP, and E/e' were significantly associated with MACEs in HFpEF (n = 41). In HFrEF (n = 116), several echocardiography parameters and blood tests were significantly associated with MACEs. Conclusions: Optimal examination timing for prognostication is different between echocardiography but not for blood tests. TTE before discharge provides more information in both HF phenotypes, while blood tests play a role both upon admission and before discharge. Therefore, a pre-discharge TTE was recommended in patients admitted for HF. (C) 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.