Miura Masanobu, Sugimura Koichiro, Sakata Yasuhiko, Miyata Satoshi, Tadaki Soichiro, Yamauchi Takeshi, Onose Takeo, Tsuji Kanako, Abe Ruri, Oikawa Takuya, Kasahara Shintaro, Nochioka Kotaro, Takahashi Jun, Shimokawa Hiroaki
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine.
Circ J. 2016 May 25;80(6):1396-403. doi: 10.1253/circj.CJ-16-0216. Epub 2016 May 12.
It remains to be elucidated whether addition of renin-angiotensin-aldosterone system (RAAS) inhibitors and/or β-blockers to loop diuretics has a beneficial prognostic impact on chronic heart failure (CHF) patients.
From the Chronic Heart failure Analysis and Registry in the Tohoku district 2 (CHART-2) Study (n=10,219), we enrolled 4,134 consecutive patients with symptomatic stage C/D CHF (mean age, 69.3 years, 67.7% male). We constructed Cox models for composite of death, myocardial infarction, stroke and HF admission. On multivariate inverse probability of treatment weighted (IPTW) Cox modeling, loop diuretics use was associated with worse prognosis with hazard ratio (HR) 1.28 (P<0001). Furthermore, on IPTW multivariate Cox modeling for multiple treatments, both low-dose (<40 mg/day) and high-dose (≥40 mg/day) loop diuretics were associated with worse prognosis with HR 1.32 and 1.56, respectively (both P<0.001). Triple blockade with RAS inhibitor(s), mineral corticoid (aldosterone) receptor antagonist(s) (MRA), and β-blocker(s) was significantly associated with better prognosis in those on low-dose but not on high-dose loop diuretics.
Chronic use of loop diuretics is significantly associated with worse prognosis in CHF patients in a dose-dependent manner, whereas the triple combination of RAAS inhibitor(s), MRA, and β-blocker(s) is associated with better prognosis when combined with low-dose loop diuretics. (Circ J 2016; 80: 1396-1403).
在袢利尿剂基础上加用肾素-血管紧张素-醛固酮系统（RAAS）抑制剂和/或β受体阻滞剂对慢性心力衰竭（CHF）患者的预后是否有益仍有待阐明。
从日本东北地区慢性心力衰竭分析与注册研究2（CHART-2）（n = 10219）中，我们连续纳入了4134例有症状的C/D期CHF患者（平均年龄69.3岁，男性占67.7%）。我们构建了死亡、心肌梗死、卒中和心力衰竭住院复合终点的Cox模型。在多变量治疗逆概率加权（IPTW）Cox模型中，使用袢利尿剂与较差的预后相关，风险比（HR）为1.28（P<0.001）。此外，在多治疗方案的IPTW多变量Cox模型中，低剂量（<40mg/天）和高剂量（≥40mg/天）袢利尿剂均与较差的预后相关，HR分别为1.32和1.56（均P<0.001）。在低剂量但非高剂量袢利尿剂使用者中，RAAS抑制剂、盐皮质激素（醛固酮）受体拮抗剂（MRA）和β受体阻滞剂三联阻滞与较好的预后显著相关。
慢性使用袢利尿剂与CHF患者较差的预后显著相关，且呈剂量依赖性，而RAAS抑制剂、MRA和β受体阻滞剂三联联合低剂量袢利尿剂时与较好的预后相关。（《循环杂志》2016年；80：1396 - 1403）
