Department of Cardiology, Rhode Island Hospital, Brown University, Providence, RI, USA.
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
ESC Heart Fail. 2018 Oct;5(5):858-863. doi: 10.1002/ehf2.12299. Epub 2018 Jun 14.
The aim of this study was to identify echocardiographic predictors of improved or worsening renal function during intravenous diuresis for decompensated heart failure. Secondary aim included defining the incidence and clinical risk factors for acute changes in renal function with decongestion.
A retrospective review of 363 patients admitted to a single centre for decompensated heart failure who underwent intravenous diuresis and transthoracic echocardiography was conducted. Clinical, echocardiographic, and renal function data were retrospectively collected. A multinomial logistic regression model was created to determine relative risk ratios for improved renal function (IRF) or worsening renal function (WRF). Within this cohort, 36% of patients experienced WRF, 35% had stable renal function, and 29% had IRF. Patients with WRF were more likely to have a preserved left ventricular ejection fraction compared with those with stable renal function or IRF (P = 0.02). Patients with IRF were more likely to have a dilated, hypokinetic right ventricle compared with those with stable renal function or WRF (P ≤ 0.01), although this was not significant after adjustment for baseline characteristics. Left atrial size, left ventricular linear dimensions, and diastolic function did not significantly predict change in renal function.
An acute change in renal function occurred in 65% of patients admitted with decompensated heart failure. WRF was statistically more likely in patients with a preserved left ventricular ejection fraction. A trend towards IRF was noted in patients with global right ventricular dysfunction.
本研究旨在确定心力衰竭失代偿患者静脉利尿时肾功能改善或恶化的超声心动图预测因素。次要目的包括确定充血性心力衰竭患者利尿后肾功能急性变化的发生率和临床危险因素。
对在单个中心因心力衰竭失代偿而接受静脉利尿和经胸超声心动图检查的 363 例患者进行了回顾性研究。回顾性收集了临床、超声心动图和肾功能数据。采用多项逻辑回归模型确定改善肾功能（IRF）或肾功能恶化（WRF）的相对风险比。在该队列中，36%的患者出现 WRF，35%的患者肾功能稳定，29%的患者肾功能改善。与肾功能稳定或 IRF 患者相比，WRF 患者的左心室射血分数更有可能保留（P=0.02）。与肾功能稳定或 WRF 患者相比，IRF 患者更有可能出现扩张性、低动力性右心室（P≤0.01），但在调整基线特征后无统计学意义。左心房大小、左心室线性尺寸和舒张功能不能显著预测肾功能的变化。
心力衰竭失代偿患者入院时 65%的患者肾功能发生急性变化。射血分数保留的患者发生 WRF 的可能性更大。在整体右心室功能障碍的患者中，IRF 的趋势明显。
