What is the management approach for patients with abnormal cardiac indices?

From the Guidelines

The management of patients with abnormal cardiac indices should focus on identifying and treating the underlying cause, with referral to a cardiologist and application of evidence-based guideline-directed medical therapy, including cardiac rehabilitation, beta blockers, ACE inhibitors, ARBs, ARNIs, aldosterone antagonists, GLP-1 analogues, and SGLT-2 inhibitors, as recommended by the most recent study 1.

Key Considerations

• The goal of management is to improve mortality, functional status, and prevent future heart failure hospitalizations, as outlined in the study 1.
• For patients with heart failure with reduced ejection fraction (HFrEF), evidence-based guideline-directed medical therapy should be applied, including cardiac rehabilitation, beta blockers, ACE inhibitors, ARBs, ARNIs, aldosterone antagonists, GLP-1 analogues, and SGLT-2 inhibitors 1.
• For patients with heart failure with preserved ejection fraction (HFpEF), blood pressure control, use of aldosterone antagonists, coronary revascularization when appropriate, and maintenance of sinus rhythm should be considered to improve symptoms 1.

Management Approach

• Initial management should include a comprehensive assessment of the patient's hemodynamic status, including blood pressure, heart rate, and signs of end-organ perfusion.
• Pharmacologic therapy should be tailored to the individual patient's needs, with consideration of medications such as beta blockers, ACE inhibitors, ARBs, ARNIs, aldosterone antagonists, GLP-1 analogues, and SGLT-2 inhibitors.
• Continuous hemodynamic monitoring is essential during treatment, with parameters reassessed every 1-2 hours in unstable patients.
• Mechanical circulatory support devices may be necessary for patients who don't respond to pharmacologic therapy.

Additional Recommendations

• Lifestyle modifications, such as smoking cessation, improving diet, reducing dietary salt, and increasing physical activity, may also be beneficial in managing patients with abnormal cardiac indices, as suggested by the study 1.
• Achieving adequate blood pressure control and promoting left ventricular hypertrophy (LVH) regression is a central management goal, as discussed in the study 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Management Approach for Patients with Abnormal Cardiac Indices

The management approach for patients with abnormal cardiac indices involves various strategies, including the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs).

• Use of ACEIs and ARBs: Studies have shown that ACEIs and ARBs can be beneficial in patients with heart failure, including those with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) 2, 3.
• Hemodynamic Parameters: The use of ACEIs and ARBs has been associated with improvements in hemodynamic parameters, such as systemic vascular resistance (SVR) and mean arterial pressure (MAP), although the effect on cardiac index (CI) may be variable 2, 4.
• Clinical Outcomes: The use of ACEIs and ARBs has been associated with improved clinical outcomes, including reduced mortality and heart failure readmissions 2, 3.
• Exercise Capacity: The effect of ACEIs and ARBs on exercise capacity in patients with HFpEF is unclear, with some studies suggesting no significant improvement 3.
• Cardiac Structure and Function: The use of ACEIs and ARBs may be associated with improvements in left ventricular (LV) structure and function, including increased ejection fraction (EF) 3.
• Biomarkers: Elevated levels of soluble angiotensin-converting enzyme 2 (sACE2) have been associated with increased biomarkers of cardiac injury and neurohormonal activation, as well as impaired diastolic function and increased risk of cardiovascular events 5.

Considerations for Patients Undergoing Cardiac Catheterization

For patients undergoing cardiac catheterization, the use of ACEIs and ARBs may need to be carefully considered, particularly in those with renal insufficiency 6.

• Withholding ACEIs and ARBs: Withholding ACEIs and ARBs prior to cardiac catheterization may be associated with a reduced risk of contrast-induced acute kidney injury (AKI) 6.
• Continuation of ACEIs and ARBs: However, continuing ACEIs and ARBs may be beneficial in patients with heart failure, and the decision to withhold or continue these medications should be made on a case-by-case basis 2.