Effect of Acoustic Cardiography-guided Management on One-year Outcomes in Patients with Acute Heart Failure.
J Card Fail. 2019 Sep 27;:
Authors: Sung SH, Huang CJ, Cheng HM, Huang WM, Yu WC, Chen CH
Abstract
BACKGROUND: The electromechanical activation time (EMAT) normalized by cardiac cycle length (%EMAT) and the third heart sound (S3) strength measured with automated acoustic cardiography are predictive of post-discharge adverse events in patients with acute heart failure (AHF). The aim of this study was to evaluate whether the acoustic cardiography-guided management improves outcomes in patients with AHF when compared with the conventional therapy.
METHODS AND RESULTS: This prospective single-blind study randomized 225 AHF patients (age 74.1±14.5 years, 26.2% women, and left ventricular ejection fraction 38.4±14.4%) before discharge to the EMAT-guided group (n=114) with the post-discharge treatment goals to reduce %EMAT to <15% and S3 <5, and the symptom-guided group (n=111) to adjust medications without the knowledge of the results of acoustic cardiography. The primary endpoints were re-hospitalization for heart failure and total mortality during one-year follow-up. The two groups were well-matched in age and pre-discharge %EMAT and S3 strength. After a mean follow-up period of 238.1±140.8 days, a significant reduction in the primary endpoints was seen in the EMAT-guided group compared with the symptom-guided group (43 events vs. 61 events, P =0.0095). Kaplan-Meier curves demonstrated significant differences in the time to first event, favoring the EMAT-guided group in the total study population (n=225, hazard ratio and 95% confidence interval: 0.61, 0.42-0.91, log-rank P = 0.0129), as well as in the pre-specified subgroup of patients with a pre-discharge %EMAT >15% (n=85; 0.32, 0.16-0.65, P = 0.0008).
CONCLUSIONS: In patients hospitalized due to AHF, EMAT-guided post-discharge management was superior to the conventional symptoms-driven therapy in terms of one-year outcomes. (NCT01298232).
PMID: 31568829 [PubMed - as supplied by publisher]