Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czechia,
Department of Cardiovascular, Respiratory, Nephrological, Anaesthetic and Geriatric Sciences, "Sapienza" University, Rome, Italy,
Kidney Blood Press Res. 2019;44(5):1271-1284. doi: 10.1159/000502975. Epub 2019 Sep 25.
Some patients with heart failure (HF) are more prone to systemic congestion than others. The goal of this study was to identify clinical and humoral factors linked to congestion and its prognostic impact in HF patients.
A total of 371 advanced HF patients underwent physical examination, echocardiography, right heart catheterization, blood samplings, and Minnesota Living with HF Questionnaire. Subjects were followed-up for adverse events (death, urgent transplantation, or assist device implantation without heart transplantation).
Thirty-one percent of patients were classified as prone to congestion. During a median follow-up of 1,093 days, 159 (43%) patients had an adverse event. In the Cox analysis, the congestion-prone (CP) status was associated with a 43% higher event risk. The CP status was strongly (p ˂ 0.001) associated with body weight loss, right ventricular dysfunction (RVD), dilated inferior vena cava (IVC), diuretics, and beta-blockers prescription and the majority of tested hormones in the univariate analysis. In the multivariate analysis, the only independent variables associated with the CP status were adiponectin, albumin, IVC diameter, and RVD. Adiponectin by itself was predictive of adverse events. In a multivariate model, CP status was no longer predictive of adverse events, in contrast to adiponectin.
CP patients experienced more severe symptoms and had shorter survival. Potential role of adiponectin, a new independent predictor of CP status, should be further examined.
部分心力衰竭（HF）患者比其他患者更容易出现全身性充血。本研究旨在确定与充血相关的临床和体液因素及其对 HF 患者预后的影响。
共纳入 371 例晚期 HF 患者，进行体格检查、超声心动图、右心导管检查、血液采样和明尼苏达州心力衰竭生活质量问卷评估。对患者进行不良事件（死亡、紧急移植或辅助设备植入而无需心脏移植）随访。
31%的患者被归类为易发生充血。在中位随访 1093 天期间，159 例（43%）患者发生不良事件。在 Cox 分析中，充血倾向（CP）状态与 43%的更高事件风险相关。CP 状态与体重减轻、右心室功能障碍（RVD）、扩张的下腔静脉（IVC）、利尿剂和β受体阻滞剂的使用以及在单变量分析中检测到的大多数激素均具有强烈相关性（p ˂ 0.001）。在多变量分析中，与 CP 状态相关的唯一独立变量是脂联素、白蛋白、IVC 直径和 RVD。脂联素本身可预测不良事件。在多变量模型中，CP 状态不再是不良事件的预测因素，而脂联素则相反。
CP 患者的症状更严重，生存率更低。脂联素作为 CP 状态的新独立预测因子，其潜在作用应进一步研究。
