Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic.
Eur J Heart Fail. 2015 Nov;17(11):1161-71. doi: 10.1002/ejhf.417. Epub 2015 Oct 14.
The goal of the study was to examine the prognostic impact, haemodynamic and clinical features associated with lung congestion in patients with chronic heart failure (HF).
HF patients (n = 186) and HF-free controls (n = 21) underwent right heart catheterization, echocardiography, pulmonary function testing and chest radiography that was blindly scored for the presence and severity of lung oedema. Lung congestion correlated directly with pulmonary vascular resistance (PVR, P = 0.004) and inversely with pulmonary artery (PA) compliance (P < 0.001) and the diffusion limit for carbon monoxide (DLCO , P = 0.009). Compared with dry lung HF, wet lung HF patients (congestion score > median) had 25% lower PA compliance and 25-35% higher PVR, transpulmonary gradients and PA pressures (40 vs. 32 mmHg, P < 0.001) despite marginally higher PA wedge pressure (PAWP; 22 vs. 19 mmHg, P = 0.002). Wet lung HF patients displayed more right ventricular (RV) dilatation and dysfunction, more restrictive ventilation and greater reduction of DLCO . The strongest correlates of lung congestion were NT-proBNP, haemoglobin, albumin, and glomerular filtration, all surpassing PAWP. After a median of 333 days (interquartile range 80-875), 59 patients (32%) died. Lung congestion was associated with reduced survival (P < 0.0001), even after adjusting for PAWP, NT-proBNP, anaemia, CAD and renal dysfunction.
Interstitial lung oedema is associated with pulmonary vascular disease, RV overload and dysfunction and increased mortality in HF. These data reinforce the importance of aggressive decongestion in HF and suggest that novel agents aimed at reducing lung water may help to deter progression of pulmonary vascular disease and biventricular HF.
本研究旨在探讨慢性心力衰竭（HF）患者肺充血的预后影响、血液动力学和临床特征。
186 例 HF 患者和 21 例 HF 对照组接受了右心导管检查、超声心动图、肺功能检查和胸部 X 线检查，这些检查均对肺水肿的存在和严重程度进行了盲法评分。肺充血与肺血管阻力（PVR，P=0.004）直接相关，与肺动脉（PA）顺应性（P<0.001）和一氧化碳弥散量（DLCO，P=0.009）呈负相关。与干肺 HF 相比，湿肺 HF 患者（充血评分>中位数）PA 顺应性低 25%，PVR、跨肺梯度和 PA 压力高 25-35%（40 对 32mmHg，P<0.001），尽管 PA 楔压（PAWP）略高（22 对 19mmHg，P=0.002）。湿肺 HF 患者表现出更大的右心室（RV）扩张和功能障碍、更明显的限制性通气和 DLCO 更大程度的降低。与肺充血相关性最强的是 NT-proBNP、血红蛋白、白蛋白和肾小球滤过率，均超过 PAWP。中位数为 333 天后（四分位距 80-875），59 例（32%）患者死亡。即使在校正了 PAWP、NT-proBNP、贫血、CAD 和肾功能不全后，肺充血仍与生存率降低相关（P<0.0001）。
间质肺水肿与 HF 中的肺血管疾病、RV 超负荷和功能障碍以及死亡率增加相关。这些数据强化了 HF 积极去充血的重要性，并表明旨在减少肺水的新型药物可能有助于阻止肺血管疾病和双心室 HF 的进展。
