Rubio Gracia J, Giménez López I, Josa Laorden C, Sánchez Marteles M, Garcés Horna V, de la Rica Escuín M L, Pérez Calvo J I
Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, España.
Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, España; Facultad de Medicina, Universidad de Zaragoza, Zaragoza, España; Instituto Aragonés de Ciencias de la Salud, Zaragoza, España.
Rev Clin Esp. 2020 Jul 9. doi: 10.1016/j.rce.2020.01.011.
The increase in intraabdominal pressure (IAP) has been correlated with increased creatinine levels in patients with heart failure with severely reduced left ventricular ejection fraction (HFrEF). However, IAP has not been examined in more stable patients or those with heart failure with preserved ejection fraction (HFpEF).
We conducted an observational, prospective descriptive study that measured the IAP of patients hospitalised for decompensated heart failure (HF). The sample was stratified according to left ventricular ejection fraction (LVEF), with a cut-off of 50%. The objective was to analyse the IAP, the baseline characteristics and degree of congestion using clinical ultrasonography and impedance audiometry.
The study included 56 patients, 22 with HFrEF and 34 with HFpEF. The patients with HFrEF presented a higher prevalence of ischaemic heart disease (11% vs. 6%; p = 0.010) and chronic obstructive pulmonary disease/asthma (6% vs. 2%; p = 0.025). The IAP was higher in the patients with HFrEF (17.2 vs. 13.3 mmHg; p = 0.004), with no differences in renal function at admission according to the LVEF (CKD-EPI creatinine) (HFrEF 55.0 mL/min/1.73 m [32.6-83.6] vs. HFpEF 55.0 mL/min/1.73 m [44.0-74.9]; p = 0.485). The patients with HFrEF presented a more congestive profile determined through ultrasonography (inferior vena cava collapse [26% vs. 50%; p = 0.001]), impedance audiometry (total body water at admission, 46 L vs. 41 L; p = 0.052; and at 72 h, 50.2 L vs. 39.1 L; p = 0.038) and CA125 concentration (68 U/mL vs. 39 U/mL; p = 0.037).
During the decompensation episodes, the patients with HFrEF had a greater increase in IAP and a higher degree of systemic congestion.
腹内压（IAP）升高与左心室射血分数严重降低的心力衰竭（HFrEF）患者肌酐水平升高相关。然而，尚未对病情更稳定的患者或射血分数保留的心力衰竭（HFpEF）患者的IAP进行研究。
我们进行了一项观察性、前瞻性描述性研究，测量因失代偿性心力衰竭（HF）住院患者的IAP。样本根据左心室射血分数（LVEF）分层，临界值为50%。目的是使用临床超声检查和阻抗听力测定法分析IAP、基线特征和充血程度。
该研究纳入了56例患者，其中22例为HFrEF，34例为HFpEF。HFrEF患者缺血性心脏病（11%对6%；p = 0.010）和慢性阻塞性肺疾病/哮喘（6%对2%；p = 0.025）的患病率更高。HFrEF患者的IAP更高（17.2对13.3 mmHg；p = 0.004），根据LVEF（CKD-EPI肌酐）入院时肾功能无差异（HFrEF为55.0 mL/min/1.73 m²[32.6 - 83.6]，HFpEF为55.0 mL/min/1.73 m²[44.0 - 74.9]；p = 0.485）。通过超声检查（下腔静脉塌陷[26%对50%；p = 0.001]）、阻抗听力测定法（入院时全身水含量，46 L对41 L；p = 0.052；72小时时，50.2 L对39.1 L；p = 0.038）和CA125浓度（68 U/mL对39 U/mL；p = 0.037）确定，HFrEF患者的充血情况更严重。
在失代偿期，HFrEF患者的IAP升高幅度更大，全身充血程度更高。
