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下腔静脉直径与慢性心力衰竭患者的预后相关,与三尖瓣反流速度无关。

Inferior vena cava diameter is associated with prognosis in patients with chronic heart failure independent of tricuspid regurgitation velocity.

机构信息

School of Cardiovascular & Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.

Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.

出版信息

Clin Res Cardiol. 2023 Aug;112(8):1077-1086. doi: 10.1007/s00392-023-02178-4. Epub 2023 Mar 10.

Abstract

AIMS

A high, Doppler-derived, tricuspid regurgitation velocity (TRV) indicates pulmonary hypertension, which may contribute to right ventricular dysfunction and worsening tricuspid regurgitation leading to systemic venous congestion, reflected by an increase in inferior vena cava (IVC) diameter. We hypothesized that venous congestion rather than pulmonary hypertension would be more strongly associated with prognosis.

METHODS AND RESULTS

895 patients with chronic heart failure (CHF) (median (25th and 75th centile) age 75 (67-81) years, 69% men, LVEF 44 (34-55)% and NT-proBNP 1133 (423-2465) pg/ml) were enrolled. Compared to patients with normal IVC (< 21 mm) and TRV (≤ 2.8 m/s; n = 504, 56%), those with high TRV but normal IVC (n = 85, 9%) were older, more likely to be women and to have LVEF ≥ 50%, whilst those with dilated IVC but normal TRV (n = 142, 16%) had more signs of congestion and higher NT-proBNP. Patients (n = 164, 19%) with both dilated IVC and high TRV had the most signs of congestion and the highest NT-proBNP. During follow-up of 860 (435-1121) days, 239 patients died. Compared to those with both normal IVC and TRV (reference), patients with high TRV but normal IVC did not have a significantly increased mortality (HR: 1.41; CI: 0.87-2.29; P = 0.16). Risk was higher for patients with a dilated IVC but normal TRV (HR: 2.51; CI: 1.80-3.51; P < 0.001) or both a dilated IVC and elevated TRV (HR: 3.27; CI: 2.40-4.46; P < 0.001).

CONCLUSION

Amongst ambulatory patients with CHF, a dilated IVC is more closely associated with an adverse prognosis than an elevated TRV.

摘要

目的

较高的三尖瓣反流速度(TRV),多普勒衍生,表明存在肺动脉高压,这可能导致右心室功能障碍和三尖瓣反流恶化,导致体静脉充血,下腔静脉(IVC)直径增加。我们假设静脉充血而非肺动脉高压与预后的相关性更强。

方法和结果

895 名慢性心力衰竭(CHF)患者(中位数(25 百分位数和 75 百分位数)年龄 75(67-81)岁,69%为男性,LVEF 44(34-55)%和 NT-proBNP 1133(423-2465)pg/ml)被纳入研究。与 IVC 正常(<21mm)和 TRV(≤2.8m/s;n=504,56%)的患者相比,TRV 较高但 IVC 正常(n=85,9%)的患者年龄较大,更可能为女性,LVEF≥50%,而 IVC 扩张但 TRV 正常(n=142,16%)的患者有更多充血的迹象和更高的 NT-proBNP。IVC 和 TRV 均扩张的患者(n=164,19%)有最多的充血迹象和最高的 NT-proBNP。在 860(435-1121)天的随访中,有 239 名患者死亡。与 IVC 和 TRV 均正常的患者(参考)相比,TRV 较高但 IVC 正常的患者死亡率无显著增加(HR:1.41;95%CI:0.87-2.29;P=0.16)。IVC 扩张但 TRV 正常的患者(HR:2.51;95%CI:1.80-3.51;P<0.001)或 IVC 和 TRV 均扩张的患者(HR:3.27;95%CI:2.40-4.46;P<0.001)的风险更高。

结论

在门诊慢性心力衰竭患者中,扩张的 IVC 与不良预后的相关性比升高的 TRV 更密切。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5ded/10359207/5d96911419be/392_2023_2178_Fig1_HTML.jpg

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