急性失代偿后出院的心力衰竭患者中利尿剂抵抗公式的六个月预测价值。
Six-Month Predictive Value of Diuretic Resistance Formulas in Discharged Heart Failure Patients after an Acute Decompensation.
作者信息
Feola Mauro, Rossi Arianna, Testa Marzia, Ferreri Cinzia, Palazzuoli Alberto, Pastorini Guido, Ruocco Gaetano
机构信息
Cardiology Division, Ospedale Regina Montis Regalis, Mondovi' ASL CN1, 12084 Cuneo, Italy.
School of Geriatry, Universita' degli Studi Torino, 10124 Torino, Italy.
出版信息
J Clin Med. 2020 Sep 11;9(9):2932. doi: 10.3390/jcm9092932.
BACKGROUND
The diuretic response has been shown to be a robust independent marker of cardiovascular outcomes in acute heart failure patients. The objectives of this clinical research are to analyze two different formulas (diuretic response (DR) or response to diuretic (R-to-D)) in predicting 6-month clinical outcomes.
METHODS
Consecutive patients discharged alive after an acute decompensated heart failure (ADHF) were enrolled. All patients underwent N-terminal-pro hormone BNP (NT-proBNP) and an echocardiogram together with DR and R-to-D calculation during diuretic administration. Death by any cause, cardiac transplantation and worsening heart failure (HF) requiring readmission to hospital were considered cardiovascular events.
RESULTS
263 patients (62% male, age 78 years) were analyzed at 6-month follow-up. During the follow-up 58 (22.05%) events were scheduled. Patients who experienced CV-event had a worse renal function ( = 0.001), a higher NT-proBNP ( = 0.001), a lower left ventricular ejection fraction ( = 0.01), DR ( = 0.02) and R-to-D ( = 0.03). Spearman rho's correlation coefficient showed a strong direct correlation between DR and R to D in all patients (r = 0.93; < 0.001) and both in heart failure with reduced ejection fraction (HFrEF) (r = 0.94; < 0.001) and HF preserved ejection fraction (HFpEF) (r = 0.91; < 0.001). At multivariate analysis, a value of R-to-D <1.69 kg/40 mg, but only <0.67 kg/40 mg for DR were significantly related to poor 6-month outcome ( = 0.04 and = 0.05, respectively). Receiver operating characteristic (ROC) curve analyses demonstrated that DR and R-to-D are equivalent in predicting prognosis (area under curve (AUC): 0.39 and 0.40, respectively). Only R-to-D was inversely related to in-hospital stay (r = -0.23; = 0.01).
CONCLUSION
Adding diuresis to DR seemed to provide a better risk assessment in alive HF patients discharged after an acute decompensation.
背景
利尿剂反应已被证明是急性心力衰竭患者心血管预后的一个有力独立标志物。本临床研究的目的是分析两种不同的公式（利尿剂反应（DR）或对利尿剂的反应（R-to-D））在预测6个月临床结局方面的作用。
方法
纳入急性失代偿性心力衰竭（ADHF）后存活出院的连续患者。所有患者在利尿剂给药期间均接受了N末端脑钠肽前体（NT-proBNP）、超声心动图检查，并计算了DR和R-to-D。任何原因导致的死亡、心脏移植以及需要再次入院的心力衰竭（HF）恶化均被视为心血管事件。
结果
在6个月的随访中分析了263例患者（男性占62%，年龄78岁）。随访期间发生了58例（22.05%）事件。发生心血管事件的患者肾功能较差（P = 0.001）、NT-proBNP较高（P = 0.001）、左心室射血分数较低（P = 0.01）、DR（P = 0.02）和R-to-D（P = 0.03）。Spearman相关系数显示，在所有患者中DR与R-to-D之间存在强正相关（r = 0.93；P < 0.001），在射血分数降低的心力衰竭（HFrEF）患者中（r = 0.94；P < 0.001）以及射血分数保留的心力衰竭（HFpEF）患者中（r = 0.91；P < 0.001）也是如此。在多变量分析中，R-to-D值<1.69 kg/40 mg，但DR仅<0.67 kg/40 mg与6个月不良结局显著相关（分别为P = 0.04和P = 0.05）。受试者工作特征（ROC）曲线分析表明，DR和R-to-D在预测预后方面相当（曲线下面积（AUC）分别为0.39和0.40）。只有R-to-D与住院时间呈负相关（r = -0.23；P = 0.01）。
结论
在DR中加入利尿似乎能为急性失代偿后存活出院的心力衰竭患者提供更好的风险评估。
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