Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
Cardiac Surgery, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
Eur J Heart Fail. 2015 Sep;17(9):917-24. doi: 10.1002/ejhf.325. Epub 2015 Jul 27.
Although acute heart failure (AHF) is a potential complication of acute aortic syndromes (AAS), its clinical details and management implications have been scarcely evaluated. This study aimed to assess prevalence, pathophysiological mechanisms, impact on treatment, and in-hospital mortality of AHF in AAS.
Data were collected from a prospective AAS registry (398 patients diagnosed between 2000 and 2013). Patients with AHF were identified by the presence of dyspnoea as the presentation symptom or radiological signs of pulmonary congestion or cardiogenic shock, including patients with cardiac tamponade (CT). AHF frequency was 28% (Stanford type A 32% vs. type B 20%, P = 0.01). Four mechanisms leading to AHF were identified, alone or in combination: CT (26%), aortic regurgitation (25%), myocardial ischaemia (17%), and hypertensive crisis (10%). In type A patients, aortic regurgitation and CT were the most frequent mechanisms, whereas myocardial ischaemia and hypertensive crisis were the most frequent in type B patients. Although no difference was noted for diagnostic times, AHF at presentation led to a longer surgical delay in type A AAS. In-hospital mortality was higher in patients with AHF compared with those without (34% vs. 17%, P < 0.001). After multivariable analysis, AHF was associated with increased risk of in-hospital death (adjusted odds ratio 1.97, 95% confidence interval 1.14-3.36, P = 0.014).
AHF occurs in more than a quarter of patients with AAS of both type A and type B, is due to a variety of pathophysiological mechanisms, and is associated with increased surgical delay and in-hospital mortality.
尽管急性心力衰竭（AHF）是急性主动脉综合征（AAS）的潜在并发症，但对其临床细节和管理意义尚未进行充分评估。本研究旨在评估 AAS 中 AHF 的患病率、病理生理机制、对治疗的影响和院内死亡率。
数据来自前瞻性 AAS 登记处（2000 年至 2013 年间诊断的 398 例患者）。通过呼吸困难作为主要症状或影像学显示肺充血或心源性休克（包括心脏压塞患者）的存在来确定 AHF 患者。AHF 的频率为 28%（Stanford 型 A 为 32%，型 B 为 20%，P=0.01）。确定了导致 AHF 的 4 种机制，单独或联合存在：心脏压塞（26%）、主动脉瓣反流（25%）、心肌缺血（17%）和高血压危象（10%）。在型 A 患者中，主动脉瓣反流和心脏压塞是最常见的机制，而在型 B 患者中，心肌缺血和高血压危象是最常见的机制。尽管在诊断时间上没有差异，但 AHF 在 AAS 型 A 患者中表现时导致手术延迟更长。与无 AHF 的患者相比，有 AHF 的患者院内死亡率更高（34%比 17%，P<0.001）。多变量分析后，AHF 与院内死亡风险增加相关（调整后的优势比 1.97，95%置信区间 1.14-3.36，P=0.014）。
AAS 患者中，无论是 A 型还是 B 型，AHF 的发生率均超过四分之一，其发生与多种病理生理机制有关，并与手术延迟和院内死亡率增加相关。
