Castro Renata R T, Lechnewski Luka, Homero Alan, Albuquerque Denilson Campos de, Rohde Luis Eduardo, Almeida Dirceu, David João, Rassi Salvador, Bacal Fernando, Bocchi Edimar, Moura Lidia
Brigham and Womens Hospital - Medicine, Boston - EUA.
Hospital Naval Marcilio Dias, Rio de Janeiro, RJ - Brasil.
Arq Bras Cardiol. 2021 Jan;116(1):77-86. doi: 10.36660/abc.20190439.
The physical examination enables prognostic evaluation of patients with decompensated heart failure (HF), but lacks reliability and relies on the professional's clinical experience. Considering hemodynamic responses to "fight or flight" situations, such as the moment of admission to the emergency room, we proposed the calculation of the acute hemodynamic index (AHI) from values of heart rate and pulse pressure.
To evaluate the in-hospital prognostic ability of AHI in decompensated HF.
A prospective, multicenter, registry-based observational study including data from the BREATHE registry, with information from public and private hospitals in Brazil. The prognostic ability of the AHI was tested by receiver-operating characteristic (ROC) analyses, C-statistics, Akaike's information criteria, and multivariate regression analyses. p-values < 0.05 were considered statistically significant.
We analyzed data from 463 patients with heart failure with low ejection fraction. In-hospital mortality was 9%. The median AHI value was used as cut-off (4 mmHg⋅bpm). A low AHI (≤ 4 mmHg⋅bpm) was found in 80% of deceased patients. The risk of in-hospital mortality in patients with low AHI was 2.5 times that in patients with AHI > 4 mmHg⋅bpm. AHI independently predicted in-hospital mortality in acute decompensated HF (sensitivity: 0.786; specificity: 0.429; AUC: 0.607 [0.540-0.674]; p = 0.010) even after adjusting for comorbidities and medication use [OR: 0.061 (0.007-0.114); p = 0.025).
The AHI independently predicts in-hospital mortality in acute decompensated HF. This simple bed-side index could be useful in an emergency setting. (Arq Bras Cardiol. 2021; 116(1):77-86).
体格检查有助于对失代偿性心力衰竭（HF）患者进行预后评估，但缺乏可靠性且依赖专业人员的临床经验。考虑到对“战斗或逃跑”情况（如急诊入院时）的血流动力学反应，我们提出根据心率和脉压值计算急性血流动力学指数（AHI）。
评估AHI对失代偿性HF患者的院内预后能力。
一项前瞻性、多中心、基于注册登记的观察性研究，纳入BREATHE注册登记的数据，这些数据来自巴西的公立和私立医院。通过受试者工作特征（ROC）分析、C统计量、赤池信息准则和多变量回归分析来测试AHI的预后能力。p值<0.05被认为具有统计学意义。
我们分析了463例低射血分数心力衰竭患者的数据。院内死亡率为9%。将AHI值的中位数用作临界值（4 mmHg·bpm）。80%的死亡患者AHI较低（≤4 mmHg·bpm）。AHI低的患者院内死亡风险是AHI>4 mmHg·bpm患者的2.5倍。即使在调整合并症和药物使用情况后，AHI仍能独立预测急性失代偿性HF患者的院内死亡率（敏感性：0.786；特异性：0.429；AUC：0.607 [0.540 - 0.674]；p = 0.010）[OR：0.061（0.007 - 0.（此处原文有误，应为0.114））；p = 0.025]。
AHI能独立预测急性失代偿性HF患者的院内死亡率。这个简单的床边指标在急诊环境中可能有用。（《巴西心脏病学杂志》。2021年；116(1):77 - 86）
