Dovancescu Silviu, Pellicori Pierpaolo, Mabote Thato, Torabi Azam, Clark Andrew L, Cleland John G F
Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK.
Philips Research, Eindhoven, The Netherlands.
Eur J Heart Fail. 2017 May;19(5):643-649. doi: 10.1002/ejhf.748. Epub 2017 Mar 15.
Pharmacological therapies for heart failure (HF) aim to improve congestion, symptoms, and prognosis. Failing to take medication is a potential cause of worsening HF. Characterizing the effects of short-term medication omission could inform the development of better technologies and strategies to detect and interpret the reasons for worsening HF. We examined the effect of planned HF medication omission for 48 h on weight, echocardiograms, transthoracic bio-impedance, and plasma concentrations of NT-proBNP.
Outpatients with stable HF and an LVEF <45% were assigned to take or omit their HF medication for 48 h in a randomized, crossover trial. Twenty patients (16 men, LVEF 32 ± 9%, median NT-proBNP 962 ng/L) were included. Compared with regular medication, omission led to an increase in NT-proBNP by 99% (from 962 to 1883 ng/L, P < 0.001), systolic blood pressure by 16% (from 131 to 152 mmHg, P < 0.001), and left atrial volume by 21% (from 69 to 80 mL, P = 0.001), and reductions in transthoracic bio-impedance by 10% (from 33 to 30 Σ, P = 0.001) and serum creatinine by 8% (from 135 to 118 µmol/L, P = 0.012). No significant changes in body weight, heart rate, or LVEF were observed.
The characteristic pattern of response to short-term medication omission is of increasing congestion but, in contrast to the pattern reported for disease progression, with a rise in blood pressure and improved renal function. In stable HF, weight is not a sensitive marker of short-term diuretic omission.
心力衰竭（HF）的药物治疗旨在改善充血、症状和预后。不服用药物是导致HF恶化的一个潜在原因。明确短期停药的影响可为开发更好的技术和策略提供依据，以检测和解读HF恶化的原因。我们研究了计划48小时停用HF药物对体重、超声心动图、经胸生物阻抗和NT-proBNP血浆浓度的影响。
在一项随机交叉试验中，将左心室射血分数（LVEF）<45%的稳定HF门诊患者分配为服用或停用HF药物48小时。纳入20例患者（16例男性，LVEF 32±9%，NT-proBNP中位数962 ng/L）。与常规用药相比，停药导致NT-proBNP升高99%（从962 ng/L升至1883 ng/L，P<0.001），收缩压升高16%（从131 mmHg升至152 mmHg，P<0.001），左心房容积增加21%（从69 mL增至80 mL，P = 0.001），经胸生物阻抗降低10%（从33 Σ降至30 Σ，P = 0.001），血清肌酐降低8%（从135 µmol/L降至118 µmol/L，P = 0.012）。未观察到体重、心率或LVEF有显著变化。
短期停药的特征性反应模式是充血增加，但与疾病进展所报道的模式不同，血压升高且肾功能改善。在稳定HF中，体重不是短期停用利尿剂的敏感指标。
