Prediction Of Heart Failure By Noninvasive Output Monitoring In Patients With Acute Myocardial Infarction

[Background]The high incidence of heart failure(HF)after acute myocardial infarction(AMI)reduces the quality of life and increases the economic burden in patients.Thus,the early evaluation and intervention of HF in patients is essential.Hemodynamics monitoring plays an important role in guiding treatments and evaluation.Moreover,noninvasive hemodynamic monitoring technology continues to advance.ICON~?,the instrument based on bioelectrical impedance,rely on the principle of electrical cardiometry.It’s exhibited noninvasive,continuous,rapid,and reliable properties.Besides,ICON~?can detect changes in blood volume in patients sensitively and timely.However,there are few studies on patients of HF caused by AMI who undergoing hemodynamics monitoring used ICON~?.Therefore,ICON~?has important significance for early identification of HF in AMI patients,but relevant studies are lacking.This study will further explore the early warning effect of ICON?on HF in patients with AMI.[Objective]The aim of the present study was to investigate the role of ICON~?in patients with AMI(Killip Level I)and explore the impact on short-term prognosis of this patient with AMI(Killip Level I)monitoring by ICON~?.[Methods]A total of 131 patients with AMI(Killip level I)admitted to the Cardiovascular Department of our hospital between January 2022 and December 2022 were enrolled in this study.Hemodynamic monitoring of each patient was done with ICON~?.(1)The collected patient data included age,general,height,weight,cigarette smoking,hypertensive disease,diabetes mellitus,hypertensive disease,the results of coronary angiography and current medication.Standard transthoracic cardiac sonography and ICON~?were performed in all patients.(3)Patients were grouped according to their comorbidities,left ventricular ejection fraction(LVEF),N-terminal pro-brain natriuretic peptide(NT-pro BNP),troponin I(c Tn I),and Thoracic fluid content(TFC).(4)Hemodynamic parameters were compared between groups.The patients with high level of TFC were divided into groups based on whether they used diuretic to intervention or not.The length of critical care unit and hospital admissions,inpatient costs and in-hospital HF were compared between two groups.(5)Patients receive diuretics and in those receiving no diuretics.The rate of main adverse cardiovascular events(within three months)included HF,AMI,symptomatic arrhythmic episodes,all-cause death,nonfatal stroke individually and unstable angina pectoris.[Result](1)Patients were grouped according to combination.systolic blood pressure(SBP),systemic vascular resistance(SVR)and systemic vascular resistance index(SVRI)in AMI+hypertension group were higher than those of AMI alone,while ICON of AMI+hypertension was lower than those of AMI alone,the difference was statistically significant(P<0.05).There was no significant difference in hemodynamic indexes between AMI group and AMI+diabetes.(2)Patients were grouped according to the level of LVEF.The heart rate(HR)of the normal LVEF group was lower than that of the declining LVEF group.SBP,mean arterial pressure(MAP),stroke volume(SV),stroke output index(SI)and other indexes were higher than those of LVEF descending group.However,LVEF normal group was higher than LVEF decline shrinkage time ratio(STR),and the difference was statistically significant(P<0.05).Other hemodynamic indexes were not statistically significant between the normal LVEF group and the LVEF descending group.(3)Patients were grouped according to the level of NT-pro BNP,and it was found that SV,SI,CO,CI,FTC,ICON,LVEF in the NT-pro BNP normal group is higher than the NT-pro BNP abnormal group,SVV,SVR,STR,LVEDD is lower than the NT-pro BNP abnormal group,The difference was statistically significant(P<0.05).(4)Two groups of patients were grouped based on median value of c Tn I(21.235ug/L)as a cut-off.it was found that LVEF in the mild c Tn I increase group was higher than that in the severe c Tn I increase group,and the difference was statistically significant(P<0.05).(5)Among the patients with elevated TFC,the groups were divided according to whether diuretic intervention was used.NT-pro BNP in the diuretic intervention group decreased more significantly after treatment,the difference was statistically significant(P<0.05).patients in the diuretic intervention group had longer CCU stay and hospital stay Compared with non-diuretic intervention group.Besides,higher incidence of HF during hospitalization in the diuretic intervention group and the difference was statistically significant(P>0.05).There was no significant difference in the incidence of MACE and the rate of re-hospitalization within 3 months after follow-up.Adjusting for confounding factors,diuretic intervention based on TFC was an independent protective factor for HF during hospitalization and MACE(without 3 months)after discharge.[Conclusion]In patients with AMI(Killip Level I),hemodynamic monitored by ICON?can reflect the hemodynamics under the condition of complications,decreased LVEF,and abnormal level of NT-pro BNP.The use of diuretics according to hemodynamic indicators monitored by ICON~?was an independent protective factor for HF during hospitalization and MACE(without 3 months)after discharge.Patients early use of diuretics according to hemodynamic indicators monitored by ICON~?can improve patients’short-term prognosis.