Advocate Heart Institute, Advocate Christ Medical Center, Oak Lawn, Illinois, USA.
Division of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA.
Clin Cardiol. 2021 May;44(5):636-645. doi: 10.1002/clc.23584. Epub 2021 Mar 18.
Elevated lactic acid (LA) levels carry a poor prognosis in patients with shock. Data are lacking on the significance of LA levels in patients with acute decompensated heart failure (ADHF).
This study assessed the relationship between LA levels, hemodynamics and clinical outcomes.
This was a retrospective analysis of registry data of 100 advanced heart failure patients presenting for right heart catheterization (RHC) for concern of ADHF. LA levels (normal ≤2.1 mmol/L) were obtained prior to RHC; no significant changes in therapy were made between LA collection and RHC.
Median age was 58 (47.3, 64.8) years; 57% were receiving inotropes prior to RHC. Median pulmonary capillary wedge pressure (PCWP) and cardiac index (CI) were 28 (21, 35) mmHg and 2.0 (1.7, 2.5) L/min/m , respectively. Eighty patients had normal LA prior to RHC. There was no correlation between LA levels and PCWP (R = 0.09, p = .38); 63% of the normal LA group had a PCWP >24 mmHg. There was a moderate inverse correlation between LA and CI (R = - 0.40; p < .001); 58% of the normal LA group had a CI <2.2 L/min/m . Thirty-day survival free of death/hospice, inotrope dependence, progression to heart transplant/left-ventricular assist device implant was comparable between the normal and elevated LA groups (28% vs. 20%; p = .17).
In patients presenting with ADHF, normal LA levels do not exclude the presence of depressed CI (a hemodynamic criteria for cardiogenic shock) and may not offer accurate risk stratification. Invasive hemodynamics should not be delayed based on normal LA levels alone.
乳酸（LA）水平升高的休克患者预后不良。急性失代偿性心力衰竭（ADHF）患者的 LA 水平的意义数据尚缺乏。
本研究评估了 LA 水平、血流动力学和临床结局之间的关系。
这是一项回顾性分析，纳入了 100 例因 ADHF 就诊行右心导管检查（RHC）的晚期心力衰竭患者的登记数据。在 RHC 前采集 LA 水平（正常范围≤2.1mmol/L）；LA 采集和 RHC 之间没有显著改变治疗方案。
中位年龄为 58（47.3，64.8）岁；57%的患者在 RHC 前接受了正性肌力药物治疗。中位肺毛细血管楔压（PCWP）和心指数（CI）分别为 28（21，35）mmHg 和 2.0（1.7，2.5）L/min/m 。80 例患者在 RHC 前 LA 正常。LA 水平与 PCWP 之间无相关性（R=0.09，p=0.38）；63%的 LA 正常组患者 PCWP>24mmHg。LA 与 CI 呈中度负相关（R=-0.40；p<0.001）；58%的 LA 正常组患者 CI<2.2L/min/m 。LA 正常组和 LA 升高组 30 天死亡率/临终关怀率、正性肌力药物依赖率、进展为心脏移植/左心室辅助装置植入率无差异（28%比 20%；p=0.17）。
在 ADHF 患者中，LA 水平正常并不能排除 CI 降低（心源性休克的血流动力学标准）的存在，也不能提供准确的风险分层。不应仅根据 LA 水平正常而延迟有创血流动力学检查。
