Chioncel Ovidiu, Ambrosy Andrew P, Bubenek Serban, Filipescu Daniela, Vinereanu Dragos, Petris Antoniu, Christodorescu Ruxandra, Macarie Cezar, Gheorghiade Mihai, Collins Sean P
aInstitute of Emergency for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine and Pharmacy Carol Davila, Bucuresti, Romania bDivision of Cardiology, Duke University Medical Center, Durham NC, USA cUniversity Emergency Hospital, University of Medicine and Pharmacy Carol Davila, Bucuresti dEmergency Hospital 'Sf. Spiridon', University of Medicine and Pharmacy Gr.T.Popa, Iasi eASCAR Timisoara, University of Medicine and Pharmacy, Victor Babes Romania fCenter for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois gDepartment of Emergency Medicine Vanderbilt University - Nashville, Tennessee, USA.
J Cardiovasc Med (Hagerstown). 2016 Feb;17(2):92-104. doi: 10.2459/JCM.0000000000000192.
The objective of this study was to evaluate the clinical presentation, inpatient management, and in-hospital outcome of patients hospitalized for acute heart failure syndromes (AHFS) and classified as pulmonary edema (PE).
The Romanian Acute Heart Failure Syndromes (RO-AHFS) study was a prospective, national, multicenter registry of all consecutive patients admitted with AHFS over a 12-month period. Patients were classified at initial presentation by clinician-investigators into the following clinical profiles: acute decompensated HF, cardiogenic shock, PE, right HF, or hypertensive HF.
RO-AHFS enrolled 3224 patients and 28.7% (n = 924) were classified as PE. PE patients were more likely to present with pulmonary congestion, tachypnea, tachycardia, and elevated systolic blood pressure and less likely to have peripheral congestion and body weight increases. Mechanical ventilation was required in 8.8% of PE patients. PE patients received higher doses (i.e. 101.4 ± 27.1 mg) of IV furosemide for a shorter duration (i.e. 69.3 ± 22.3 hours). Vasodilators were given to 73.6% of PE patients. In-hospital all-cause mortality (ACM) in PE patients was 7.4%, and 57% of deaths occurred on day one. Increasing age, concurrent acute coronary syndromes, life-threatening ventricular arrhythmias, elevated BUN, left bundle branch block, inotrope therapy, and requirement for invasive mechanical ventilation were independent risk factors for ACM.
In this national registry, the PE profile was found to be a high-acuity clinical presentation with distinctive treatment patterns and a poor short-term prognosis. Advances in the management of PE may necessitate both the development of novel targeted therapies as well as systems-based strategies to identify high-risk patients early in their course.
本研究的目的是评估因急性心力衰竭综合征（AHFS）住院并归类为肺水肿（PE）的患者的临床表现、住院治疗及院内结局。
罗马尼亚急性心力衰竭综合征（RO-AHFS）研究是一项前瞻性、全国性、多中心登记研究，纳入了12个月期间所有连续收治的AHFS患者。临床研究人员在患者初次就诊时将其分为以下临床类型：急性失代偿性心力衰竭、心源性休克、PE、右心衰竭或高血压性心力衰竭。
RO-AHFS登记了3224例患者，其中28.7%（n = 924）被归类为PE。PE患者更易出现肺充血、呼吸急促、心动过速和收缩压升高，而外周充血和体重增加的可能性较小。8.8%的PE患者需要机械通气。PE患者接受更高剂量（即101.4±27.1mg）的静脉注射呋塞米，且用药时间更短（即69.3±22.3小时）。73.6%的PE患者使用了血管扩张剂。PE患者的院内全因死亡率（ACM）为7.4%，57%的死亡发生在第1天。年龄增加、并发急性冠状动脉综合征、危及生命的室性心律失常、血尿素氮升高、左束支传导阻滞、使用正性肌力药物治疗以及需要有创机械通气是ACM的独立危险因素。
在这个全国性登记研究中，发现PE类型是一种高急症临床表现，具有独特的治疗模式和较差的短期预后。PE管理方面的进展可能需要开发新的靶向治疗方法以及基于系统的策略，以便在病程早期识别高危患者。
