Division of Internal Medicine and Cardiology, Turku University Hospital, Turku, Finland.
Department of Emergency Medicine and Services, Helsinki University Hospital, Turku, Finland.
ESC Heart Fail. 2018 Feb;5(1):120-128. doi: 10.1002/ehf2.12208. Epub 2017 Sep 28.
There is little evidence-based therapy existing for acute heart failure (AHF), hospitalizations are lengthy and expensive, and optimal monitoring of AHF patients during in-hospital treatment is poorly defined. We evaluated a rapid cardiothoracic ultrasound (CaTUS) protocol, combining focused echocardiographic evaluation of cardiac filling pressures, that is, medial E/e' and inferior vena cava index, with lung ultrasound (LUS) for guiding treatment in hospitalized AHF patients.
We enrolled 20 consecutive patients hospitalized for AHF, whose in-hospital treatment was guided using the CaTUS protocol according to a pre-specified treatment protocol targeting resolution of pulmonary congestion on LUS and lowering cardiac filling pressures. Treatment results of these 20 patients were compared with those of a standard care sample of 100 patients, enrolled previously for follow-up purposes. The standard care sample had CaTUS performed daily for follow-up and received standard in-hospital treatment without ultrasound guidance. All CaTUS exams were performed by a single experienced sonographer. The CaTUS-guided therapy resulted in significantly larger decongestion as defined by reduction in symptoms, cardiac filling pressures, natriuretic peptides, cumulative fluid loss, and resolution of pulmonary congestion (P < 0.05 for all) despite a shorter mean length of hospitalization. Congestion parameters were significantly lower also at discharge (P < 0.05 for all), without any significant difference in these parameters on admission. The treatment arm displayed better survival regarding the combined endpoint of 6 month all-cause death or AHF re-hospitalization (log rank P = 0.017). No significant difference in adverse events occurred between the groups.
The CaTUS-guided therapy for AHF resulted in greater decongestion during shorter hospitalization without increased adverse events in this small pilot study and might be associated with a better post-discharge prognosis.
急性心力衰竭（AHF）的现有循证治疗方法有限，住院时间长且费用高，AHF 患者住院期间的最佳监测方法也尚未明确。我们评估了一种快速心胸超声（CaTUS）方案，该方案结合了心脏充盈压的超声评估，即 E/e' 和下腔静脉指数，以及肺部超声（LUS），以指导住院 AHF 患者的治疗。
我们纳入了 20 例连续住院的 AHF 患者，根据旨在通过 LUS 上肺部充血消退和降低心脏充盈压来治疗的预定义治疗方案，使用 CaTUS 方案指导这些患者的住院治疗。将这 20 例患者的治疗结果与之前为随访目的纳入的 100 例标准治疗组患者的结果进行比较。标准治疗组患者每天进行 CaTUS 检查以进行随访，并接受没有超声指导的标准住院治疗。所有 CaTUS 检查均由一名经验丰富的超声医师进行。尽管住院时间平均缩短，但 CaTUS 指导的治疗导致了更明显的充血消退，表现为症状、心脏充盈压、利钠肽、累积液体丢失和肺部充血消退的改善（所有 P<0.05）。出院时充血参数也明显降低（所有 P<0.05），入院时这些参数无明显差异。治疗组在 6 个月的全因死亡或 AHF 再住院的联合终点方面显示出更好的生存结果（对数秩检验 P=0.017）。两组之间不良事件发生率无显著差异。
在这项小型试点研究中，CaTUS 指导的 AHF 治疗在缩短住院时间的同时，可显著提高充血消退程度，且不增加不良事件，可能与出院后预后改善有关。
