title: Prognostic implication of physical signs of congestion in acute heart failure patients and its association with steady-state biomarker levels.
abstract: BACKGROUND
  Congestive physical findings such as pulmonary rales and third heart sound (S3) are hallmarks of acute heart failure (AHF). However, their role in outcome prediction remains unclear. We sought to investigate the association between congestive physical findings upon admission, steady-state biomarkers at the time of discharge, and long-term outcomes in AHF patients.
  
  
  METHODS
  We analyzed the data of 133 consecutive AHF patients with an established diagnosis of ischemic or non-ischemic (dilated or hypertrophic) cardiomyopathy, admitted to a single-center university hospital between 2006 and 2010. The treating physician prospectively recorded major symptoms and congestive physical findings of AHF: paroxysmal nocturnal dyspnea, orthopnea, pulmonary rales, jugular venous distension (JVD), S3, and edema. The primary endpoint was defined as rehospitalization for HF.
  
  
  RESULTS
  Majority (63.9%) of the patients had non-ischemic etiology and, at the time of admission, S3 was seen in 69.9% of the patients, JVD in 54.1%, and pulmonary rales in 43.6%. The mean follow-up period was 726 ± 31 days. Patients with pulmonary rales (p < 0.001) and S3 (p  =  0.011) had worse readmission rates than those without these findings; the presence of these findings was also associated with elevated troponin T (TnT) levels at the time of discharge (odds ratio [OR] 2.8; p  =  0.02 and OR 2.6; p  =  0.05, respectively).
  
  
  CONCLUSIONS
  Pulmonary rales and S3 were associated with inferior readmission rates and elevated TnT levels on discharge. The worsening of the readmission rate owing to congestive physical findings may be a consequence of on-going myocardial injury.
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Sayoko
authors.initials: S
authors.lastname: Negi
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Sawano
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Shun
authors.initials: S
authors.lastname: Kohsaka
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Inohara
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Shiraishi
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kohno
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Maekawa
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Motoaki
authors.initials: M
authors.lastname: Sano
authors.affiliation: Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yoshikawa
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism*; D009202:Cardiomyopathies / Q000378:metabolism / Q000473:pathology; D004417:Dyspnea / Q000378:metabolism / Q000473:pathology; D004487:Edema / Q000378:metabolism / Q000473:pathology; D005260:Female; D005921:Glomerulonephritis / Q000378:metabolism / Q000473:pathology; D006333:Heart Failure / Q000196:embryology / Q000473:pathology*; D006470:Hemorrhage / Q000378:metabolism / Q000473:pathology; D006760:Hospitalization; D006801:Humans; D008171:Lung Diseases / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D015415:Biomarkers