Civera Jose, Miñana Gema, de la Espriella Rafael, Santas Enrique, Sastre Clara, Mollar Anna, Conesa Adriana, Martínez Ana, Núñez Eduardo, Bayés-Genís Antoni, Núñez Julio
Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain.
Department of Medicine, Universitat de València, Valencia, Spain.
Front Cardiovasc Med. 2022 Jul 8;9:847450. doi: 10.3389/fcvm.2022.847450. eCollection 2022.
Venous leg compression (VLC) with elastic bandages has been proposed as a potentially useful strategy for decreasing tissue congestion. We aimed to evaluate the effect of VLC on short-term changes on intravascular refill, assessed by inferior vena cava (IVC) diameter in patients with worsening heart failure (WHF) requiring parenteral furosemide. Additionally, we sought to evaluate whether early changes in IVC were related to short-term decongestion.
This is a prospective study in which we included 20 consecutive ambulatory patients with WHF treated with subcutaneous furosemide and VLC for at least 72 h. The endpoints were (a) short-term changes in IVC, (b) the association between decongestion and 3-h IVC changes following VLC. Changes in continuous endpoints and their longitudinal trajectories were estimated with linear mixed regression models. All analyses were adjusted for multiple comparisons.
Following administration of subcutaneous furosemide and VLC, we found a significant increase in 3-h IVC diameter (ΔIVC = 1.6 mm, CI 95%: 0.7-2.5; < 0.001), with a greater increase in those with baseline IVC≤21 mm (2.4 vs. 0.8 mm; < 0.001). 3-h intravascular refill (increase in IVC≥2 mm) was associated with greater decongestion (natriuresis, weight, peripheral edemas, and dyspnea) in those with baseline IVC≤21 mm but not when IVC>21 mm ( < 0.05 for all comparisons).
In this cohort of patients with congestive WHF treated with subcutaneous furosemide and VLC, we found a greater increase in short-term IVC in those with IVC ≤21 mm at baseline. In this subset of patients, a 3-h increase in IVC≥2 mm was associated with greater short-term decongestion.
已有人提出使用弹性绷带进行腿部静脉压迫（VLC）作为减轻组织充血的一种潜在有效策略。我们旨在评估VLC对需要肠外使用呋塞米的失代偿性心力衰竭（WHF）患者血管再充盈短期变化的影响，通过下腔静脉（IVC）直径进行评估。此外，我们试图评估IVC的早期变化是否与短期去充血有关。
这是一项前瞻性研究，我们纳入了20例连续的门诊WHF患者，这些患者接受皮下呋塞米和VLC治疗至少72小时。终点指标为：（a）IVC的短期变化；（b）VLC后3小时IVC变化与去充血之间的关联。使用线性混合回归模型估计连续终点指标的变化及其纵向轨迹。所有分析均针对多重比较进行了校正。
在给予皮下呋塞米和VLC后，我们发现3小时时IVC直径显著增加（ΔIVC = 1.6 mm，95%置信区间：0.7 - 2.5；P < 0.001），基线IVC≤21 mm的患者增加幅度更大（2.4 vs. 0.8 mm；P < 0.001）。基线IVC≤21 mm的患者中，3小时血管再充盈（IVC增加≥2 mm）与更大程度的去充血（利钠、体重、外周水肿和呼吸困难）相关，但IVC>21 mm时则不然（所有比较P < 0.05）。
在这组接受皮下呋塞米和VLC治疗的充血性WHF患者中，我们发现基线IVC≤21 mm的患者短期IVC增加幅度更大。在这一患者亚组中，IVC在3小时内增加≥2 mm与更大程度的短期去充血相关。
