Diagnostic and Prognostic Value of Cardiac Biomarkers and Echocardiography for Patients Hospitalized Due to Acute Dyspnea: Prospective Observational Multicenter Cohort Study

Heart failure (HF) is believed to be the modern-day epidemic due to increasing incidence, impaired long-term prognosis and huge economic burden. With the ageing population the impact of HF on health care resources is on the rise. The course of the disease is characterized by episodes of acute decompensation that mark a significant turning point in the progress of the disease, with in-hospital mortality rates as high as 10%. Acute heart failure (AHF) is a gradual or rapid change in HF signs and symptoms, requiring urgent medical therapies. Acute heart failure is estimated to be the most costly and the most frequent cause of admission to emergency wards. Emergency department (ED) is the primary setting where initial AHF management takes place. However, strong evidence for diagnostics and management of this grave condition is still lacking. Even less is known about the prevalence, diagnosis and management of acute right ventricular failure (RVF).

A patient presenting to the ED with acute dyspnea has to undergo numerous procedures in order to differentiate the diagnosis between AHF, chronic obstructive pulmonary disease, pneumonia, pulmonary embolism and other etiologies. Moreover, the majority of HF patients suffer from comorbidities that make the diagnostic process even more challenging. Due to numerous exams and tests, the initial management of these patients may be delayed, resulting in an extended hospital length of stay, increased rate of complications and death. The clinical, hemodynamic and neurohormonal features of heart failure are different in specific patient populations and depend on age, sex, race, left ventricular ejection fraction and co-existent right ventricular (RV) dysfunction as well as many other factors.

Cardiac biomarkers are easily reproducible and objective laboratory tests that could help to improve early AHF diagnosis and risk stratification. However, reported data suggest varying prognostic and diagnostic values of natriuretic peptides, such as N-type natriuretic peptide (BNP), N-terminal pro B-type natriuretic peptide (NT-proBNP), MR pro-atrial natriuretic peptide (MR-proANP), as well as regional differences of these markers. Specific biomarkers of RVF have not yet been described, thus a search of novel serologic markers that could rapidly and reliably help diagnose acute RVF is a very important scientific task in cardiology. Furthermore, the knowledge on the incidence of RVF syndrome as well as the diagnostic and prognostic values of ultrasound RV structural and functional parameters is scarce. During this study the RV-focused ultrasound examination will be performed in the early hospitalization period, and blood samples will be taken and frozen at the same time. Up to 15 novel cardiac, vascular, renal impairment and inflammation biomarkers in plasma samples during acute phase of RVF will be investigated during the study in France, INSERM laboratory. The study will be unique as it will aggregate large scale observational and biomarkers database of AHF patients in Lithuania together with innovative ultrasound parameters of RV failure (quantitative parameters of RV systolic function and deformation).

The aim of this project is to find the specific novel biomarkers of acute heart failure (AHF), to evaluate their diagnostic and prognostic role in association with echocardiographic parameters of AHF.

The primary endpoint is 1-year all-cause mortality and rehospitalization.