Mene-Afejuku Tuoyo O, Akinlonu Adedoyin, Dumancas Carissa, Lopez Persio D, Cardenas Ramiro, Sueldo Carla, Veranyan Shushan, Salazar Peggy, Visco Ferdinand, Pekler Gerald, Mushiyev Savi
Department of Medicine, New York Medical College, Metropolitan Hospital Center , New York , NY , USA.
Division of Cardiology, `New York Medical College, Metropolitan Hospital Center , New York , NY , USA.
Hosp Pract (1995). 2019 Aug;47(3):130-135. doi: 10.1080/21548331.2019.1628615. Epub 2019 Jun 14.
: To identify predictors of pulmonary hypertension (PHT) and the predictive value of PHT for rehospitalization among patients with heart failure with reduced ejection fraction (HFrEF). : A retrospective study of 351 hospitalized patients with heart failure (HF). Patients 18 years and above with HFrEF secondary to non-ischemic cardiomyopathy were reviewed. Patients with coronary artery disease, preserved ejection fraction and other secondary causes of PHT apart from HF were excluded. PHT as a predictor of 30-day and six-month re-admission was assessed as well as important possible predictors of PHT. Cox regression analysis, multiple linear regression as well as other statistical tools were employed as deemed appropriate. : Thirty-seven (37) and 99 patients were re-hospitalized within 30 days and 6 months after discharge for decompensated HF, respectively. After Cox regression analysis, higher hemoglobin reduced the odds of rehospitalization for decompensated HF (p = 0.015) within 30 days after discharge while higher pulmonary artery systolic pressure (PASP) (p = 0.002) and blood urea nitrogen (BUN) (p = 0.041) increased the odds of rehospitalization within 6 months of discharge. The predictors of the PHT among patients with HFrEF after multiple linear regression were low BMI (p = 0.027), increasing age (p = 0.006) and increased left atrial diameter (LAD) on echocardiography (p = 0.0001). : Patients with HFrEF have a high predisposition to developing PHT if at admission, they have low BMI, dilated left atrium or are older. Patients with one or more of these attributes may need more intensive therapy to reduce the risk of developing PHT and in turn reduce readmission rates.
确定射血分数降低的心力衰竭(HFrEF)患者中肺动脉高压(PHT)的预测因素以及PHT对再次住院的预测价值。
对351例住院心力衰竭(HF)患者进行回顾性研究。纳入18岁及以上继发于非缺血性心肌病的HFrEF患者。排除患有冠状动脉疾病、射血分数保留以及除HF以外其他PHT继发原因的患者。评估PHT作为30天和6个月再次入院的预测因素以及PHT的重要潜在预测因素。根据需要采用Cox回归分析、多元线性回归以及其他统计工具。
分别有37例和99例患者在出院后30天和6个月内因失代偿性HF再次住院。Cox回归分析显示,较高的血红蛋白降低了出院后30天内失代偿性HF再次住院的几率(p = 0.015),而较高的肺动脉收缩压(PASP)(p = 0.002)和血尿素氮(BUN)(p = 0.041)增加了出院后6个月内再次住院的几率。多元线性回归后,HFrEF患者中PHT的预测因素为低体重指数(BMI)(p = 0.027)、年龄增加(p = 0.006)以及超声心动图显示左心房直径(LAD)增大(p = 0.0001)。
HFrEF患者如果入院时BMI低、左心房扩大或年龄较大,则发生PHT的倾向较高。具有这些特征中一项或多项的患者可能需要更强化的治疗以降低发生PHT的风险,进而降低再入院率。