Omar Hesham R, Guglin Maya
Internal Medicine Department, Mercy Medical Center, Clinton, IA, USA.
Division of Cardiovascular Medicine, Linda and Jack Gill Heart Institute, University of Kentucky, Lexington, KY, USA.
Biomed Res Int. 2017;2017:5734749. doi: 10.1155/2017/5734749. Epub 2017 Feb 21.
. There has been a decline in emphasis of the value of physical examination in heart failure (HF) with increased reliance on cardiac imaging. We aim to study the clinical and prognostic significance of positive hepatojugular reflux (HJR) on discharge in patients hospitalized with HF. . Using the ESCAPE trial data, patients were compared according to the presence or absence of a positive HJR on discharge. The primary study endpoints were all-cause mortality and a composite endpoint of death, rehospitalization, and cardiac transplant during the first 6 months after discharge. . Among 392 patients (age: 56 years, 74% men), the HJR correlated well with clinical and objective hemodynamic markers of volume overload including right atrial pressure (RAP, = 0.002), pulmonary capillary wedge pressure (PCWP, = 0.006), and inferior vena cava size during inspiration ( = 0.005) and expiration ( = 0.003). The RAP had the highest AUC for predicting a positive HJR on admission (AUC: 0.655, = 0.004) and discharge (AUC: 0.672, = 0.001). Cox's proportional hazards analysis revealed that a positive HJR on discharge is an independent predictor of 6-month mortality (estimated hazard ratio: 1.689; 95% CI: 1.032-2.764; = 0.037) after adjusting for age, baseline creatinine, baseline hematocrit, baseline NYHA class, chronic obstructive pulmonary disease, and the presence of tricuspid regurgitation. . The HJR should be routinely checked in patients admitted with acute HF throughout hospitalization and especially on discharge as it serves as an important prognostic marker for postdischarge outcomes.
随着对心脏成像的依赖增加，心力衰竭（HF）体格检查的价值受到的重视有所下降。我们旨在研究心力衰竭住院患者出院时肝颈静脉反流（HJR）阳性的临床和预后意义。利用ESCAPE试验数据，根据出院时HJR阳性与否对患者进行比较。主要研究终点为全因死亡率以及出院后前6个月内死亡、再住院和心脏移植的复合终点。在392例患者（年龄：56岁，74%为男性）中，HJR与容量超负荷的临床和客观血流动力学指标密切相关，包括右心房压力（RAP，r = 0.002）、肺毛细血管楔压（PCWP，r = 0.006）以及吸气时（r = 0.005）和呼气时（r = 0.003）下腔静脉大小。RAP对入院时（AUC：0.655，P = 0.004）和出院时（AUC：0.672，P = 0.001）预测HJR阳性具有最高的曲线下面积。Cox比例风险分析显示，在调整年龄、基线肌酐、基线血细胞比容、基线纽约心脏协会分级、慢性阻塞性肺疾病和三尖瓣反流的存在后，出院时HJR阳性是6个月死亡率的独立预测因素（估计风险比：1.689；95%置信区间：1.032 - 2.764；P = 0.037）。对于急性心力衰竭入院患者，应在整个住院期间，尤其是出院时常规检查HJR，因为它是出院后结局的重要预后指标。
