Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China.
NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, China.
ESC Heart Fail. 2021 Aug;8(4):3248-3256. doi: 10.1002/ehf2.13453. Epub 2021 Jun 2.
Heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) had distinct haemodynamic characteristics in the setting of acute heart failure. The aim of our study is to evaluate the differential response to aggressive diuresis in HFrEF and HFpEF.
Patients in the Diuretic Optimization Strategies Evaluation trial with left ventricular ejection fraction measurement were included (n = 300) and classified into HFrEF [left ventricular ejection fraction (LVEF) < 40%] (n = 193) and HFpEF (LVEF ≥ 40%) (n = 107). Effect of high-dose vs. low-dose furosemide strategy was compared separately in HFrEF and HFpEF. In HFrEF, high-dose strategy did not increase change in creatinine or cystatin C at 72 h [treatment difference: -0.05, 95% confidence interval (CI): -0.14 to 0.03 mg/dL; P = 0.23 for creatinine, and treatment difference: -0.06, 95% CI: -0.15 to 0.02 mg/dL; P = 0.15 for cystatin C] compared with low-dose strategy, but there were significantly more net fluid loss, weight loss, and congestion-free patients at 72 h in high-dose group. It was also associated with a significantly lower risk of composite clinical outcome of death, total hospitalizations, and unscheduled visits due to heart failure. In HFpEF, high-dose strategy significantly increased change in creatinine and cystatin C at 72 h (treatment difference: 0.16; 95% CI: 0.02-0.30 mg/dL; P = 0.03 for creatinine, and treatment difference: 0.26; 95% CI: 0.09-0.43 mg/dL; P = 0.003 for cystatin C), but did not significantly affect net fluid loss, weight loss, proportion of congestion-free patients at 72 h, and risk of the composite clinical outcome.
Acute heart failure on the basis of HFrEF and HFpEF responded differently to aggressive diuresis. Future trials should be designed separately for HFrEF and HFpEF.
射血分数降低的心力衰竭（HFrEF）和射血分数保留的心力衰竭（HFpEF）在心衰急性发作时有不同的血液动力学特征。本研究旨在评估在 HFrEF 和 HFpEF 中积极利尿的反应差异。
纳入利尿剂优化策略评估试验中左心室射血分数测量的患者（n=300），并分为 HFrEF [左心室射血分数（LVEF）<40%]（n=193）和 HFpEF（LVEF≥40%）（n=107）。分别比较 HFrEF 和 HFpEF 中高剂量与低剂量呋塞米策略的效果。在 HFrEF 中，高剂量策略在 72 小时时并未增加肌酐或胱抑素 C 的变化[治疗差异：-0.05，95%置信区间（CI）：-0.14 至 0.03mg/dL；P=0.23 对于肌酐，和治疗差异：-0.06，95%CI：-0.15 至 0.02mg/dL；P=0.15 对于胱抑素 C]与低剂量策略相比，但在高剂量组中，72 小时时的净液体丢失、体重减轻和无充血患者明显更多。它还与因死亡、总住院和因心力衰竭而计划外就诊的复合临床结局的风险显著降低相关。在 HFpEF 中，高剂量策略在 72 小时时显著增加肌酐和胱抑素 C 的变化（治疗差异：0.16；95%CI：0.02-0.30mg/dL；P=0.03 对于肌酐，和治疗差异：0.26；95%CI：0.09-0.43mg/dL；P=0.003 对于胱抑素 C），但对 72 小时时的净液体丢失、体重减轻、无充血患者的比例以及复合临床结局的风险无显著影响。
基于 HFrEF 和 HFpEF 的急性心衰对积极利尿的反应不同。未来的试验应分别针对 HFrEF 和 HFpEF 进行设计。
