Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Sakakibara Heart Institute, Tokyo, Japan.
PLoS One. 2014 May 6;9(5):e96325. doi: 10.1371/journal.pone.0096325. eCollection 2014.
Congestive physical findings such as pulmonary rales and third heart sound (S3) are hallmarks of acute heart failure (AHF). However, their role in outcome prediction remains unclear. We sought to investigate the association between congestive physical findings upon admission, steady-state biomarkers at the time of discharge, and long-term outcomes in AHF patients.
We analyzed the data of 133 consecutive AHF patients with an established diagnosis of ischemic or non-ischemic (dilated or hypertrophic) cardiomyopathy, admitted to a single-center university hospital between 2006 and 2010. The treating physician prospectively recorded major symptoms and congestive physical findings of AHF: paroxysmal nocturnal dyspnea, orthopnea, pulmonary rales, jugular venous distension (JVD), S3, and edema. The primary endpoint was defined as rehospitalization for HF.
Majority (63.9%) of the patients had non-ischemic etiology and, at the time of admission, S3 was seen in 69.9% of the patients, JVD in 54.1%, and pulmonary rales in 43.6%. The mean follow-up period was 726 ± 31 days. Patients with pulmonary rales (p < 0.001) and S3 (p = 0.011) had worse readmission rates than those without these findings; the presence of these findings was also associated with elevated troponin T (TnT) levels at the time of discharge (odds ratio [OR] 2.8; p = 0.02 and OR 2.6; p = 0.05, respectively).
Pulmonary rales and S3 were associated with inferior readmission rates and elevated TnT levels on discharge. The worsening of the readmission rate owing to congestive physical findings may be a consequence of on-going myocardial injury.
肺部啰音和第三心音（S3）等充血性物理发现是急性心力衰竭（AHF）的标志。然而，它们在预后预测中的作用仍不清楚。我们试图研究入院时充血性物理发现、出院时稳态生物标志物与 AHF 患者长期结局之间的关系。
我们分析了 2006 年至 2010 年间在一家单中心大学医院连续收治的 133 例确诊为缺血性或非缺血性（扩张型或肥厚型）心肌病的 AHF 患者的数据。主治医生前瞻性记录 AHF 的主要症状和充血性物理发现：阵发性夜间呼吸困难、端坐呼吸、肺部啰音、颈静脉扩张（JVD）、S3 和水肿。主要终点定义为因 HF 再住院。
大多数（63.9%）患者为非缺血性病因，入院时 69.9%的患者出现 S3，54.1%的患者出现 JVD，43.6%的患者出现肺部啰音。平均随访时间为 726 ± 31 天。有肺部啰音（p < 0.001）和 S3（p = 0.011）的患者再入院率比无这些发现的患者差；这些发现的存在也与出院时肌钙蛋白 T（TnT）水平升高相关（优势比[OR]分别为 2.8；p = 0.02 和 OR 2.6；p = 0.05）。
肺部啰音和 S3 与较差的再入院率和出院时升高的 TnT 水平相关。充血性物理发现导致再入院率恶化可能是持续心肌损伤的结果。
