Heart and Vascular Center at The Christ Hospital, Cincinnati, OH, USA.
Circ Heart Fail. 2013 Jul;6(4):733-9. doi: 10.1161/CIRCHEARTFAILURE.112.000309. Epub 2013 Jun 4.
Ultrafiltration (UF) is a widely used technology for inpatient management of acute decompensated heart failure in patients with volume overload. However, the safety and efficacy of UF in patients with heart failure and preserved left ventricular ejection fraction (heart failure with preserved ejection fraction [HFPEF]) need further clarification. We hypothesized that UF could be used in this population with outcomes similar to acute decompensated heart failure patients with low left ventricular ejection fraction (HFLEF).
Prospective evaluation was performed on 2 patient cohorts admitted to a single institution for acute decompensated heart failure and treated with UF: HFLEF (left ventricular ejection fraction ≤ 40%; n=87) and HFPEF (left ventricular ejection fraction >40%; n=97). Selected demographic and clinical data were compared, including clinical and serological information, as well as in-hospital and 90-day postdischarge mortality. HFPEF patients were more likely to be women, have higher blood pressures, and less likely to have ischemic heart disease. There were no significant differences in total weight loss (7.7% in HFLEF and 7.0% in HFPEF), electrolyte and renal disturbances, or in-hospital mortality (3.4% in HFLEF and 3.3% in HFPEF) between the 2 groups. Mortality at 90 days tended to be greater in HFLEF (24.1%) than in HFPEF (15.5%).
Therapeutic responses in patients with HFPEF meeting current indication for UF are similar to those with HFLEF. Larger studies are warranted to better characterize acute heart failure management with UF in this population.
超滤（UF）是一种广泛应用于容量超负荷的急性失代偿性心力衰竭住院患者管理的技术。然而，UF 在射血分数保留的心力衰竭（HFPEF）患者中的安全性和疗效仍需进一步明确。我们假设 UF 可用于该人群，其结局与低射血分数的急性失代偿性心力衰竭患者（HFLEF）相似。
对一家机构收治的接受 UF 治疗的 2 例急性失代偿性心力衰竭患者队列进行前瞻性评估：HFLEF（左心室射血分数≤40%；n=87）和 HFPEF（左心室射血分数>40%；n=97）。比较了包括临床和血清学信息在内的选定人口统计学和临床数据，以及住院期间和出院后 90 天的死亡率。HFPEF 患者更可能为女性，血压更高，且更不可能患有缺血性心脏病。2 组之间的总体重减轻（HFLEF 为 7.7%，HFPEF 为 7.0%）、电解质和肾功能障碍或住院死亡率（HFLEF 为 3.4%，HFPEF 为 3.3%）均无显著差异。HFLEF 的 90 天死亡率（24.1%）高于 HFPEF（15.5%）。
符合当前 UF 适应证的 HFPEF 患者的治疗反应与 HFLEF 患者相似。需要更大规模的研究来更好地描述 UF 在该人群中的急性心力衰竭管理。
