Servicio de Medicina Interna, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, Spain.
Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, Spain; Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain; Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain.
Rev Clin Esp (Barc). 2021 Aug-Sep;221(7):384-392. doi: 10.1016/j.rceng.2020.01.011. Epub 2021 Jun 5.
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.
在左心室射血分数严重降低的心力衰竭（HFrEF）患者中，腹内压（IAP）的增加与肌酐水平升高有关。然而，在病情更稳定的患者或射血分数保留的心力衰竭（HFpEF）患者中，尚未检查过 IAP。
我们进行了一项观察性、前瞻性描述性研究，测量了因失代偿性心力衰竭（HF）住院患者的 IAP。根据左心室射血分数（LVEF）对样本进行分层，截断值为 50%。目的是使用临床超声和阻抗听力计分析 IAP、基线特征和充血程度。
该研究纳入了 56 名患者，其中 22 名患有 HFrEF，34 名患有 HFpEF。HFrEF 患者中缺血性心脏病（11%对 6%；p=0.010）和慢性阻塞性肺疾病/哮喘（6%对 2%；p=0.025）的患病率较高。HFrEF 患者的 IAP 较高（17.2 对 13.3mmHg；p=0.004），但根据 LVEF（CKD-EPI 肌酐），入院时肾功能无差异（HFrEF 55.0mL/min/1.73m[32.6-83.6]vs.HFpEF 55.0mL/min/1.73m[44.0-74.9]；p=0.485）。通过超声心动图（下腔静脉塌陷[26%对 50%；p=0.001]）、阻抗听力计（入院时总水量，46L 对 41L；p=0.052；72 小时时，50.2L 对 39.1L；p=0.038）和 CA125 浓度（68U/mL 对 39U/mL；p=0.037），HFrEF 患者的充血程度更为明显。
在失代偿期，HFrEF 患者的 IAP 增加更多，全身充血程度更高。
