Elsevier

Journal of Cardiac Failure

Volume 26, Issue 12, December 2020, Pages 1043-1049
Journal of Cardiac Failure

Lymphocytopenia During Hospitalization for Acute Heart Failure and Its Relationship With Portal Congestion and Right Ventricular Function

https://doi.org/10.1016/j.cardfail.2020.07.001Get rights and content

Abstract

Background

Lymphocytopenia is associated with mortality in acute heart failure (AHF), and portal congestion has been suggested to play a role in leukocyte distribution. The associations between lymphocytopenia and ultrasound surrogates for portal congestion have never been studied. We aimed to characterize the determinants of lymphocytopenia, explore the associations between lymphocytopenia and portal congestion, and explore the relationships between lymphocytopenia and outcomes in AHF.

Methods and Results

Patients were compared according to tertiles of lymphocyte count (very low, <0.87 × 109/L; low, 0.87–1.2 × 109/L; or normal, >1.2 × 109/L). One hundred three patients with AHF were prospectively assessed at baseline and discharge. At baseline, 69% of patients had a lymphocyte count below the normal range. Patients with baseline very low lymphocyte count were older, had more advanced disease and higher portal vein pulsatility index when compared with those in the higher tertiles. Very low lymphocyte count at baseline was associated with age (odds ratio (OR) 1.098), portal vein pulsatility index (OR, 1.026), and tricuspid annular plane systolic excursion (OR, 0.865, all P < .05). The portal vein pulsatility index was the most powerful determinant of lymphocytopenia at discharge (OR 1.033, P < .05). In a Cox model, lymphocytopenia at discharge was associated with mortality (hazard ratio 4.796, P < .05).

Conclusions

In AHF, lymphocytopenia is associated with ultrasound surrogates for portal congestion and right ventricular dysfunction. Whether these associations depict a potent pathophysiologic pathway or whether they only reflect a more advanced disease remains uncertain.

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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