Kalogeropoulos Andreas P, Marti Catherine N, Georgiopoulou Vasiliki V, Butler Javed
Division of Cardiology, Emory University, Atlanta, Georgia.
Division of Cardiology, Emory University, Atlanta, Georgia.
J Card Fail. 2014 Aug;20(8):593-601. doi: 10.1016/j.cardfail.2014.05.006. Epub 2014 May 28.
Inotropes are widely used in hospitalized systolic heart failure (HF) patients, especially those with low systolic blood pressure (SBP) or cardiac index. In addition, inotropes are considered to be harmful in nonischemic HF.
We examined the association of in-hospital inotrope use with (1) major events (death, ventricular assist device, or heart transplant) and (2) study days alive and out of hospital during the first 6 months in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness, which excluded patients with immediate need for inotropic therapy. Predefined subgroups of interest were baseline SBP <100 versus ≥ 100 mm Hg, cardiac index <1.8 vs ≥ 1.8 L min(-1) m(-2), and ischemic versus nonischemic HF etiology. Inotropes were frequently used in both the <100 mm Hg (88/165 [53.3%]) and the ≥ 100 mm Hg (106/262 [40.5%]) SBP subgroups and were associated with higher risk for major events in both subgroups (adjusted hazard ratio [HR] 2.85, 95% confidence interval [CI] 1.59-5.12 [P < .001]; and HR 1.86, 95% CI 1.02-3.37 [P = .042]; respectively). Risk with inotropes was more pronounced among those with cardiac index ≥ 1.8 L min(-1) m(-2) (n = 114; HR 4.65, 95% CI 1.98-10.9; P < .001) vs <1.8 L min(-1) m(-2) (n = 82; HR 1.48, 95% CI 0.61-3.58; P = .39). Event rates were higher with inotropes in both ischemic (n = 215; HR 2.64, 95% CI 1.49-4.68; P = .001) and nonischemic (n = 216; HR 2.19, 95% CI 1.18-4.07; P = .012) patients. Across all subgroups, patients who received inotropes spent fewer study days alive and out of hospital.
In the absence of cardiogenic shock or end-organ hypoperfusion, inotrope use during hospitalization for HF was associated with unfavorable 6-month outcomes, regardless of admission SBP, cardiac index, or HF etiology.
正性肌力药物广泛应用于住院的收缩性心力衰竭（HF）患者，尤其是那些收缩压（SBP）低或心脏指数低的患者。此外，正性肌力药物被认为对非缺血性HF有害。
在充血性心力衰竭和肺动脉导管插入术有效性评估研究中，我们研究了住院期间使用正性肌力药物与（1）主要事件（死亡、心室辅助装置或心脏移植）以及（2）前6个月存活且出院的研究天数之间的关联，该研究排除了急需正性肌力治疗的患者。预先定义的感兴趣亚组为基线SBP<100与≥100mmHg、心脏指数<1.8与≥1.8L·min⁻¹·m⁻²以及缺血性与非缺血性HF病因。在SBP<100mmHg（88/165[53.3%]）和≥100mmHg（106/262[40.5%]）的亚组中，正性肌力药物均被频繁使用，且在两个亚组中均与主要事件的较高风险相关（调整后风险比[HR]2.85，95%置信区间[CI]1.59 - 5.12[P<.001]；以及HR 1.86，95%CI 1.02 - 3.37[P = .042]；分别）。在心脏指数≥1.8L·min⁻¹·m⁻²（n = 114；HR 4.65，95%CI 1.98 - 10.9；P<.001）的患者中，与<1.8L·min⁻¹·m⁻²（n = 82；HR 1.48，95%CI 0.61 - 3.58；P = .39）的患者相比，使用正性肌力药物的风险更为显著。在缺血性（n = 215；HR 2.64，95%CI 1.49 - 4.68；P = .001）和非缺血性（n = 216；HR 2.19，95%CI 1.18 - 4.07；P = .012）患者中，使用正性肌力药物时的事件发生率均较高。在所有亚组中，接受正性肌力药物治疗的患者存活且出院的研究天数较少。
在不存在心源性休克或终末器官灌注不足的情况下，HF住院期间使用正性肌力药物与6个月时的不良结局相关，无论入院时的SBP、心脏指数或HF病因如何。
