Department of Cardiology, Mersin University Medical Faculty, 33343, Mersin, Turkey.
Department of Cardiology, Toros State Hospital, Mersin, Turkey.
Cardiovasc Toxicol. 2020 Aug;20(4):361-369. doi: 10.1007/s12012-020-09563-9.
We aimed to determine the effect of blood lactate levels on cardiovascular (CV) death and hospitalization for heart failure (HF) in acute HF patients with reduced left ventricular ejection fraction (EF).
Eighty-five acute HF patients with reduced ejection fraction were divided into two groups according to admission blood lactate levels. 48 of them had low blood lactate levels (< 2 mmol/l) and 37 of them had high blood lactate levels (≥ 2 mmol/l). Patients with acute coronary syndrome, cardiogenic shock, sepsis and low blood pressure at admission were excluded from the study. Primary endpoint is the composite of cardiovascular (CV) death and hospitalization for heart failure (HHF) in 6-month follow-up. Secondary endpoint is the change in NT-proBNP levels from admission to 72 h.
Baseline characteristics of patients were similar in two groups. On baseline echocardiographic evaluation; patients with high lactate revealed a higher mitral E/A ratio (2.34 [0.43-3.31], p = 0.008) and a lower TAPSE ratio (14 [10-27], p = 0.008) than patients with low lactate levels. Over a median follow-up period of 6 months, the primary end point occurred in 28 (75.7%) of 37 patients assigned to high lactate group and in 20 (41.7%) of 48 patients assigned to low lactate group (p = 0.006). High lactate levels significantly increased the risk of CV death and HHF at 6 months by nearly 5.35-fold in acute HF patients with reduced EF. The change in NT-proBNP levels at 72nd hour after admission were similar between two groups.
Higher lactate levels at admission related with higher HHF at 6 months and may be related with higher risk of CV death in acute HF patients with reduced EF.
本研究旨在探讨急性射血分数降低心衰（HF）患者的血乳酸水平对心血管（CV）死亡和因心衰住院（HHF）的影响。
根据入院时血乳酸水平，将 85 例急性 HF 合并射血分数降低的患者分为两组。其中 48 例血乳酸水平较低（<2mmol/L），37 例血乳酸水平较高（≥2mmol/L）。排除急性冠状动脉综合征、心源性休克、脓毒症和入院时低血压的患者。主要终点是 6 个月随访期间的 CV 死亡和 HHF 的复合终点。次要终点是入院至 72 小时 NT-proBNP 水平的变化。
两组患者的基线特征相似。在基线超声心动图评估中，高乳酸组的患者二尖瓣 E/A 比值较高（2.34[0.43-3.31]，p=0.008），TAPSE 比值较低（14[10-27]，p=0.008）。在中位随访 6 个月期间，高乳酸组的 37 例患者中有 28 例（75.7%）发生主要终点事件，而低乳酸组的 48 例患者中有 20 例（41.7%）发生主要终点事件（p=0.006）。高乳酸水平使 EF 降低的急性 HF 患者发生 CV 死亡和 HHF 的风险在 6 个月时增加近 5.35 倍。两组患者入院后 72 小时 NT-proBNP 水平的变化相似。
入院时较高的血乳酸水平与 6 个月时较高的 HHF 发生率相关，可能与 EF 降低的急性 HF 患者 CV 死亡风险较高有关。
