Omar Hesham R, Charnigo Richard, Guglin Maya
Internal Medicine Department, Mercy Medical Center, Clinton, Iowa.
Department of Statistics, University of Kentucky, Lexington, Kentucky; Department of Biostatistics, University of Kentucky, Lexington, Kentucky.
Am J Cardiol. 2017 Apr 1;119(7):1061-1068. doi: 10.1016/j.amjcard.2016.11.062. Epub 2017 Jan 6.
Congestion is the main contributor to heart failure (HF) morbidity and mortality. We assessed the combined role of congestion and decreased forward flow in predicting morbidity and mortality in acute systolic HF. The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial data set was used to determine if the ratio of simultaneously measured systolic blood pressure (SBP)/right atrial pressure (RAP) on admission predicted HF rehospitalization and 6-month mortality. One hundred ninety-five patients (mean age 56.5 years, 75% men) who received pulmonary artery catheterization were studied. The RAP, SBP, and SBP/RAP had an area under the curve (AUC) of 0.593 (p = 0.0205), 0.585 (p = 0.0359), and 0.621 (p = 0.0026), respectively, in predicting HF rehospitalization. The SBP/RAP was a superior marker of HF rehospitalization compared with RAP alone (difference in AUC 0.0289, p = 0.0385). The optimal criterion of SBP/RAP <11 provided the highest combined sensitivity (77.1%) and specificity (50.9%) in predicting HF rehospitalization. The SBP/RAP had an AUC 0.622, p = 0.0108, and a cut-off value of SBP/RAP <8 had a sensitivity of 61.9% and specificity 64.1% in predicting mortality. Multivariate analysis showed that an SBP/RAP <11 independently predicted rehospitalization for HF (estimated odds ratio 3.318, 95% confidence interval 1.692 to 6.506, p = 0.0005) and an SBP/RAP <8 independently predicted mortality (estimated hazard ratio 2.025, 95% confidence interval 1.069 to 3.833, p = 0.030). In conclusion, SBP/RAP ratio is a marker that identifies a spectrum of complications after hospitalization of patients with decompensated systolic HF, starting with increased incidence of HF rehospitalization at SBP/RAP <11 to increased mortality with SBP/RAP <8.
充血是导致心力衰竭（HF）发病和死亡的主要因素。我们评估了充血和前向血流减少在预测急性收缩性HF发病和死亡中的联合作用。利用充血性心力衰竭和肺动脉导管插入术有效性评估研究试验数据集，来确定入院时同时测量的收缩压（SBP）/右心房压力（RAP）比值是否能预测HF再住院和6个月死亡率。对195例接受肺动脉导管插入术的患者（平均年龄56.5岁，75%为男性）进行了研究。在预测HF再住院方面，RAP、SBP和SBP/RAP的曲线下面积（AUC）分别为0.593（p = 0.0205）、0.585（p = 0.0359）和0.621（p = 0.0026）。与单独的RAP相比，SBP/RAP是HF再住院的更优标志物（AUC差异为0.0289，p = 0.0385）。SBP/RAP<11的最佳标准在预测HF再住院方面提供了最高的联合敏感性（77.1%）和特异性（50.9%）。SBP/RAP的AUC为0.622，p = 0.0108，SBP/RAP<8的临界值在预测死亡率方面的敏感性为61.9%，特异性为64.1%。多变量分析显示，SBP/RAP<11独立预测HF再住院（估计比值比3.318，95%置信区间1.692至6.506，p = 0.0005），SBP/RAP<8独立预测死亡率（估计风险比2.025，95%置信区间1.069至3.833，p = 0.030）。总之，SBP/RAP比值是一个标志物，可识别失代偿性收缩性HF患者住院后一系列并发症，从SBP/RAP<11时HF再住院发生率增加，到SBP/RAP<8时死亡率增加。
