VA Boston Healthcare System, Boston, Massachusetts 02132, USA.
J Card Fail. 2011 Sep;17(9):718-25. doi: 10.1016/j.cardfail.2011.04.014.
In patients admitted for heart failure (HF), unrecognized elevation of left ventricular end-diastolic pressure (LVEDP) at the time of discharge may have a role in the high rehospitalization rate for HF on follow-up.
In a small, prospective study (n = 50), patients admitted for HF were randomized to management guided by daily noninvasive estimated LVEDP monitoring (Group I, open) to a target LVEDP of <20 mm Hg or management based on clinical assessment alone without knowledge of the estimated LVEDP (Group II, blinded). Noninvasive estimated LVEDP was measured by the VeriCor monitor, which uses the Valsalva maneuver to derive the LVEDP. The primary endpoints were the reduction of estimated LVEDP at discharge and the HF rehospitalization rate on follow-up. Estimated LVEDP was significantly reduced at discharge in the open group compared with the blinded group (mean estimated LVEDP 19.7 ± 1.3 mm Hg vs 25.6 ± 1.5 mm Hg, respectively, P = 0.01). The rehospitalization rates for HF on follow-up were significantly improved in the open group compared with the blinded group (at 1 month: 0% vs 25%, respectively [P = .05]; at 3 months: 0% vs 32% [P = .01]; at 6 months: 4% vs 36% [P = .01]; at 1 year: 16% vs 48% [P = .03]).
When HF is managed by clinical assessment only, estimated LVEDPs remain high at discharge, resulting in early and frequent rehospitalization for HF. Therapy guided by estimated LVEDP monitoring optimizes filling pressures and reduces HF rehospitalization rates.
在因心力衰竭（HF）住院的患者中，出院时未识别的左心室舒张末期压（LVEDP）升高可能是 HF 患者在随访中再住院率高的原因。
在一项小型前瞻性研究中（n=50），因 HF 入院的患者被随机分为两组：一组接受每日非侵入性估计的 LVEDP 监测指导的治疗（I 组，开放组），目标 LVEDP<20mmHg；另一组接受单纯临床评估指导的治疗（II 组，盲法组），不了解估计的 LVEDP。非侵入性估计的 LVEDP 通过 VeriCor 监测仪测量，该监测仪使用瓦尔萨尔瓦动作来推导 LVEDP。主要终点是出院时估计的 LVEDP 降低和 HF 再住院率。与盲法组相比，开放组出院时估计的 LVEDP 显著降低（平均估计 LVEDP 分别为 19.7±1.3mmHg 和 25.6±1.5mmHg，P=0.01）。与盲法组相比，开放组 HF 的再住院率在随访中显著改善（1 个月时：0% vs 25%，分别为 [P=0.05]；3 个月时：0% vs 32%，分别为 [P=0.01]；6 个月时：4% vs 36%，分别为 [P=0.01]；1 年时：16% vs 48%，分别为 [P=0.03]）。
当 HF 仅通过临床评估进行管理时，LVEDP 在出院时仍较高，导致 HF 早期和频繁再住院。通过估计的 LVEDP 监测指导的治疗可以优化充盈压并降低 HF 再住院率。
