Right heart failure laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Jad Z Al Danaf; Rim Halaby
Overview
Laboratory tests are useless in the diagnosis heart failure, however they are essential in identifying possible precipitating factors of decompensation, assessing severity of the heart failure, monitoring the side effects of medical treatment and some serve as prognostic markers.[1] In addition, in patients with right heart failure, an arterial blood gas can be useful in assessing the degree of hypoxemia. This can in turn be used to guide therapy with oxygen.
Laboratory Tests
Complete Blood count[2]
- Anemia might trigger decompensation
ESR
- Low lymphocyte, >7000/µL basal white cell count and ESR>15mm in first hour might indicate worse prognosis
- To be repeated every 6 months unless needed to be repeated more frequently.
Serum Electrolytes and Creatinine[2]
- Hypernatremia, increase in serum creatinine and hypokalemia might result from aggressive diuretic therapy.
- Hypokalemia and hypomagnesemia as side effects of potassium-losing diuretics
- Hyperkalemia secondary to renal failure, excessive potassium intake or as a side effect of diuretics (ACR-I, ARB and spironolactone)
- Target range for K+ should be 4-5 mEq/L
- To be repeated daily to adjust dose of diuretics and then every 2-3 months in stable patients.
Serum Uric acid
- Hyperuricemia can be seen in renal failure and secondary to thiazide diuretic use. It is also seen in cardiac cachectic patients.
- To be repeated every 6 months in stable patients and 3 months in patients on high diuretic doses.
Liver Function tests
- Elevated ALK phosphatase, liver transaminases and total bilirubin can be secondary to liver congestion.
- Elevated Gamma-Glutamyltransferase values are sensitive but nonspecific indicators of heart failure.
- Hypo-albuminemia can be seen in malnutrition or renal dysfunction. It also raises the suspicion of protein losing enteropathy which necessitates checking stool alpha-1 antitrypsin level.
- To be repeated every 6-12 months in stable patients, during every heart failure decompensatory episode and in pathologic weight loss.
Coagulation tests
- INR especially during anticoagulant therapy or in setting of hepatic dysfunction-nutmeg liver.
Cardiac Troponins
- Highly sensitive troponin I (hs-cTnI) servea as outcome predictors with more sensitivity then cardiac Toponin T (cTnT).
Thyroid hormones
- Must be measured in cases of atrial fibrillation, dilated cardiomyopathy, patient on amiodarone therapy and in patients older than 65 years of age.
- Blood Glucose level in non-diabetics
- High Blood glucose level in non-diabetic patients can be secondarily to high diuretic doses such as thiazide diuretics.
Neurohormonal prognostic markers
- B-type natriuretic peptide and NT-proBNP
- Endothelin-1
- Miscellaneous (Plasma rennin activity, ANP, NE, hsCRP, calitonin gene related peptide, prostaglandins, erythropoietin…)[3][4][5][6]
References
- ↑ Tago WH, Francis GS, Morrow DA, et al. National Academy of Clinical Biochemistry Laboratory Medicine. National Academy of Clinical Biochemistry Laboratory Medicine practice guidelines: Clinical utilization of cardiac biomarker testing in heart failure. Circulation. 2007; 116:e90-e109.
- ↑ 2.0 2.1 Van der Meer P. and Van Veldhuisen DJ. Anaemia and renal dysfunction in chronic heart failure. Heart. 2009; 95: 1808-1812.
- ↑ Haddad F. et al. Right Ventricular function in Cardiovascular Disease, Part II: Pathophysiology, Clinical Importance and Management of Right Ventricular failure. Circulation. 2008;117:1717-1731
- ↑ Maeder M, Fehr T, Rickli H, Ammann P. Sepsis-associated myocardial dysfunction: diagnostic and prognostic impact of cardiac troponins and natriuretic peptides. Chest. 2006;129:1349 –1366.
- ↑ Pousset F, Isnard R, Lecnat R et al. Prognostic value of plasma endothelin-1 in patients with chroninc heart failure. Eur Heart J. 1997; 18:254-258.
- ↑ Hobbs RE. Using BNP to diagnose, manage, and treat heart failure. Cleve Clin J Med 2003;70:333–6.