Department of Heart and Vessels, Viale Morgagni, 85, Florence, Italy.
Eur J Heart Fail. 2011 Mar;13(3):337-46. doi: 10.1093/eurjhf/hfq207. Epub 2010 Dec 3.
To evaluate the clinical, biohumoral, and haemodynamic effects of ultrafiltration vs. intravenous diuretics in patients with decompensated heart failure (HF). Signs and symptoms of volume overload are often present in these patients and standard therapy consists primarily of intravenous diuretics. Increasing evidence suggests that ultrafiltration can be an effective alternative treatment.
Thirty patients with decompensated HF were randomly assigned to diuretics or ultrafiltration. Haemodynamic variables, including several novel parameters indicating the overall performance of the cardiovascular system, were continuously assessed with the Pressure Recording Analytical Method before, during, at the end of treatment (EoT) and 36 h after completing treatment. Aldosterone and N-terminal pro-B-type natriuretic peptide (NT-proBNP) plasma levels were also measured. Patients treated with ultrafiltration had a more pronounced reduction in signs and symptoms of HF at EoT compared with baseline, and a significant decrease in plasma aldosterone (0.24 ± 0.25 vs. 0.86 ± 1.04 nmol/L; P < 0.001) and NT-proBNP levels (2823 ± 2474 vs. 5063 ± 3811 ng/L; P < 0.001) compared with the diuretic group. The ultrafiltration group showed a significant improvement (% of baseline) in a number of haemodynamic parameters, including stroke volume index (114.0 ± 11.7%; P < 0.001), cardiac index (123.0 ± 20.8%; P < 0.001), cardiac power output (114.0 ± 13.8%; P < 0.001), dP/dt(max) (129.5 ± 19.9%; P < 0.001), and cardiac cycle efficiency (0.24 ± 0.54 vs. -0.14 ± 0.50 units; P < 0.05), and a significant reduction in systemic vascular resistance 36 h after the treatment (88.0 ± 10.9%; P < 0.001), which was not observed in the diuretic group.
In patients with advanced HF, ultrafiltration facilitates a greater clinical improvement compared with diuretic infusion by ameliorating haemodynamics (assessed using a minimally invasive methodology) without a marked increase in aldosterone or NT-proBNP levels.
评估超滤与静脉利尿剂在失代偿性心力衰竭（HF）患者中的临床、生物化学和血液动力学效果。这些患者通常存在容量超负荷的体征和症状，标准治疗主要包括静脉利尿剂。越来越多的证据表明，超滤可以作为一种有效的替代治疗方法。
30 名失代偿性 HF 患者被随机分配至利尿剂或超滤组。使用压力记录分析方法在治疗前、治疗期间、治疗结束时（EoT）和治疗结束后 36 小时连续评估血流动力学变量，包括几个表明心血管系统整体性能的新参数。还测量了醛固酮和 N 末端 pro-B 型利钠肽（NT-proBNP）的血浆水平。与基线相比，超滤组在 EoT 时 HF 的体征和症状有更明显的减轻，并且血浆醛固酮（0.24±0.25 与 0.86±1.04 nmol/L；P<0.001）和 NT-proBNP 水平（2823±2474 与 5063±3811 ng/L；P<0.001）显著降低与利尿剂组相比。超滤组在许多血液动力学参数方面均有显著改善（与基线相比的%），包括心搏量指数（114.0±11.7%；P<0.001）、心指数（123.0±20.8%；P<0.001）、心脏做功量（114.0±13.8%；P<0.001）、dp/dt(max)（129.5±19.9%；P<0.001）和心脏周期效率（0.24±0.54 与-0.14±0.50 单位；P<0.05），并且在治疗后 36 小时观察到全身血管阻力显著降低（88.0±10.9%；P<0.001），而利尿剂组则没有观察到这一现象。
在晚期 HF 患者中，与静脉输注利尿剂相比，超滤通过改善血液动力学（使用微创方法评估），而不会显著增加醛固酮或 NT-proBNP 水平，从而更有利于临床改善。
