Baudry Guillaume, Bourdin Juliette, Mocan Raluca, Hugon-Vallet Elisabeth, Pozzi Matteo, Jobbé-Duval Antoine, Paulo Nicolas, Rossignol Patrick, Sebbag Laurent, Girerd Nicolas
Service d'insuffisance Cardiaque, Hôpital Cardiovasculaire Louis Pradel, 69500 Bron, France.
Centre d'Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F-CRIN INI-CRCT, Université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France.
J Clin Med. 2022 Jun 24;11(13):3663. doi: 10.3390/jcm11133663.
Heart transplantation (HT) remains the gold-standard treatment but is conditioned by organ shortage. This study aimed to evaluate the value of Forrester classification and determine which congestion criteria had the best prognostic value to predict cardiorenal events on heart transplant waiting list.
One hundred consecutive patients (54 years old, 72% men) with available right heart catheterization (RHC) listed in our center for HT between 2014 and 2019 were included. Cardiac catheterization measurements were obtained at the time of HT listing evaluation. Patients were classified according to perfusion and congestion status in four groups: "warm and dry", "warm and wet", "cold and dry", and "cold and wet". pWet was used to classify patients with pulmonary congestion and sWet for systemic congestion. The primary endpoint was the rate of a composite criteria of cardiogenic shock, acute kidney injury, and acute heart failure. Secondary endpoint was the incidence of waitlist death, emergency HT, or left ventricular assist device (LVAD) implantation at 12 months evaluated by Kaplan-Meier curves and log-rank test. Only Forrester classification according to systemic congestion was associated with the primary composite endpoint ( = 0.011), while patients' profile according to pulmonary congestion was not ( = 0.331). Similarly, only the Forrester classification according to systemic congestion predicted waitlist death, emergency HT, or LVAD implantation at 12 months, with = 0.010 and = 0.189 for systemic and pulmonary congestion, respectively. Moreover, systemic congestion was the main driver of cardiorenal events on waitlist.
Forrester classification according to systemic congestion is associated with cardiorenal outcomes in patients listed for heart transplant and the risk of waitlist death, emergency HT, or LVAD implantation at 12 months.
心脏移植（HT）仍然是金标准治疗方法，但受器官短缺的限制。本研究旨在评估Forrester分类的价值，并确定哪些充血标准对预测心脏移植等待名单上的心肾事件具有最佳的预后价值。
纳入了2014年至2019年间在我们中心连续列出的100例有可用右心导管检查（RHC）的患者（54岁，72%为男性），他们因HT而被列入名单。在HT名单评估时进行心脏导管检查测量。根据灌注和充血状态将患者分为四组：“温暖干燥”、“温暖湿润”、“寒冷干燥”和“寒冷湿润”。pWet用于对有肺充血的患者进行分类，sWet用于对全身充血的患者进行分类。主要终点是心源性休克、急性肾损伤和急性心力衰竭的复合标准发生率。次要终点是通过Kaplan-Meier曲线和对数秩检验评估的12个月时等待名单死亡、紧急HT或左心室辅助装置（LVAD）植入的发生率。只有根据全身充血的Forrester分类与主要复合终点相关（P = 0.011），而根据肺充血的患者特征则不相关（P = 0.331）。同样，只有根据全身充血的Forrester分类预测了12个月时等待名单死亡、紧急HT或LVAD植入，全身充血和肺充血的P分别为0.010和0.189。此外，全身充血是等待名单上心肾事件的主要驱动因素。
根据全身充血的Forrester分类与心脏移植等待名单上患者的心肾结局以及12个月时等待名单死亡、紧急HT或LVAD植入的风险相关。
