Department of Cardiology, Kasugai Municipal Hospital.
Department of Cardiology, Nagoya University Graduate School of Medicine.
Circ J. 2020 May 25;84(6):958-964. doi: 10.1253/circj.CJ-19-1128. Epub 2020 Apr 21.
Clinical congestion is the most dominant feature in patients with acute decompensated heart failure (HF). However, uncertainty exists due to the permutations and combinations of congestion status and decongestion strategies. This study investigated the effect of congestion status and its improvement on 1-year mortality.
In all, 453 consecutive patients hospitalized for acute decompensated HF between July 2015 and March 2017 were prospectively included in the study. Congestion was evaluated using the congestion score. The 1-year mortality rate was 22.7%. The mean (±SD) congestion scores at admission, on Day 3, and at discharge were 10.7±3.9, 3.4±3.5, and 0.3±0.8, respectively. The improvement rate in congestion scores during the first 3 days was 78%; 46.6% of patients had residual congestion. The Day 3 congestion score and the improvement rate during the first 3 days were related to 1-year all-cause mortality and cardiovascular mortality. Combined predictive values were examined by calculating multivariable-adjusted hazard ratios for associations of residual congestion and improvement rate during the first 3 days, and prognostic variables identified by the Cox regression model. Residual congestion and lesser improvement (<64%) were associated with higher relative risk of 1-year all-cause mortality and cardiovascular mortality than residual congestion and higher improvement (≥64%) or resolved congestion.
Rapid decongestion could be a prerequisite regardless of residual congestion in hospitalized acute decompensated HF patients.
临床充血是急性失代偿性心力衰竭（HF）患者最主要的特征。然而，充血状态和充血缓解策略的排列组合存在不确定性。本研究调查了充血状态及其改善对 1 年死亡率的影响。
共前瞻性纳入 2015 年 7 月至 2017 年 3 月期间因急性失代偿性 HF 住院的 453 例连续患者。使用充血评分评估充血。1 年死亡率为 22.7%。入院时、第 3 天和出院时的平均（±SD）充血评分分别为 10.7±3.9、3.4±3.5 和 0.3±0.8。第 3 天充血评分和前 3 天的充血评分改善率分别为 78%；46.6%的患者仍有充血。第 3 天的充血评分和前 3 天的改善率与 1 年全因死亡率和心血管死亡率相关。通过计算 Cox 回归模型中确定的预后变量的多变量调整风险比，评估第 3 天的残余充血和前 3 天的改善率的联合预测值。与残余充血和较高的改善（≥64%）或缓解充血相比，残余充血和改善程度较低（＜64%）与 1 年全因死亡率和心血管死亡率的相对风险增加相关。
无论住院的急性失代偿性 HF 患者是否有残余充血，快速充血缓解都可能是一个前提条件。
