title: Echocardiographic changes during treatment of acute decompensated heart failure: insights from the ESCAPE trial.
abstract: BACKGROUND
  Long-term heart failure (HF) treatment has been shown to result in reverse chamber remodeling. However, it is unknown whether sizes of cardiac chambers acutely change during HF therapy and whether these changes are associated with favorable clinical outcomes.
  
  
  RESULTS
  Using the Evaluation Study of Congestive Heart Failure and Pulsmonary Artery Catheterization Effectiveness (ESCAPE) trial database, echocardiographic parameters at baseline and discharge, changes from baseline to discharge, and their association with the combined endpoint of death or HF rehospitalization (HFH) at 6 months were evaluated in patients admitted with acute decompensated HF (ADHF). Also, the correlation between changes in invasive hemodynamic parameters compared with changes in echocardiographic parameters was analyzed. During the treatment of ADHF, right atrium, right ventricle, and inferior vena cava (IVC) sizes decreased acutely. Mitral regurgitation severity and mitral inflow parameters also improved significantly. However, the majority of acute changes in echocardiographic parameters did not have an impact on clinical outcome, except for the reduction in left ventricular (LV) end-diastolic and end-systolic volumes, which was associated with a reduction in the combined outcome of HFH or death. The change in invasive hemodynamics that best correlated with change in echocardiographic parameters was change in pulmonary capillary wedge pressure with change in IVC diameter and IVC collapsibility.
  
  
  CONCLUSIONS
  This is the first study to identify the echocardiographic parameters that change during the treatment of ADHF and the echocardiographic parameters that most reliably correlate with invasive hemodynamic changes. Most changes in echocardiographic parameters were not associated with clinical outcomes, except for the reduction in LV volume, which was associated with a reduction in HFH or death.
authors.affiliation: Department of Cardiology, Michael E. DeBakey Veterans Administration Medical Center, Baylor College of Medicine, Houston, Texas, USA. kumudhar@bcm.tmc.edu
authors.forename: Kumudha
authors.initials: K
authors.lastname: Ramasubbu
authors.forename: Anita
authors.initials: A
authors.lastname: Deswal
authors.forename: Wenyaw
authors.initials: W
authors.lastname: Chan
authors.forename: David
authors.initials: D
authors.lastname: Aguilar
authors.forename: Biykem
authors.initials: B
authors.lastname: Bozkurt
mesh_terms: D000208:Acute Disease; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency; D009026:Mortality; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013997:Time Factors; D014463:Ultrasonography; D014481:United States; D020257:Ventricular Remodeling