Lymphocytopenia During Hospitalization for Acute Heart Failure and Its Relationship With Portal Congestion and Right Ventricular Function
Section snippets
Patients Selection
This study was approved by the Montreal Heart Institute ethics board, and all patients provided written informed consent. Patients with signs and symptoms of AHF, New York Heart Association functional class II–IV symptoms managed with intravenous diuretics from April 2017 to November 2018 were evaluated for the present study. Exclusion criteria are presented in Supplementary Figure S1.
Study Design and Ultrasound Protocol for the Assessment of Portal Congestion
Clinical, biological, and ultrasound assessments were prospectively obtained at the time of hospital admission
Baseline Characteristics
From the 105 patients originally included, 2 were excluded because of extreme values of lymphocytes at baseline (known stable hemopathies), leaving 103 patients that were included in the present analysis (Supplementary Figure S1). Notably, no patient was on long-term oral corticosteroids. Patients were male (73.8%) with a mean age of 74.0 ± 11.3 years. One-half of the patients were diabetic and 32.0% had ischemic cardiomyopathy (Table 1). Patients mostly presented in New York Heart Association
Discussion
The main original finding of the present work is the strong association linking low lymphocyte count, a marker of systemic inflammation, and Doppler-derived PVPI, a surrogate for portal congestion in AHF. This hypothesis-generating study provides novel insights into the abdominal contributions to systemic inflammation in AHF.
Conclusions
Low lymphocyte count in patients hospitalized for AHF is associated with RV dysfunction and ultrasound markers of portal congestion. Whether this association supports the role of portal congestion as a pathophysiologic mechanism directly involved in lymphocytopenia in AHF or whether these 2 features only reflect a more advanced disease remains to be determined.
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