López-Vilella Raquel, Jover Pastor Pablo, Donoso Trenado Víctor, Sánchez-Lázaro Ignacio, Martínez Dolz Luis, Almenar Bonet Luis
Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
Hellenic J Cardiol. 2023 Sep-Oct;73:1-7. doi: 10.1016/j.hjc.2023.03.009. Epub 2023 Apr 15.
The treatment of congestion in heart failure (HF) is a challenge despite the therapeutic arsenal available. The aim of this study was to analyze different combinations of diuretics used to resolve congestion in patients admitted for decompensated HF and to define clinical profiles according to these treatments.
Single-center study of 1,559 patients admitted for decompensated HF was done between 2016 and 2020. Patients were grouped according to the diuretic combination that led to clinical stabilization and discharge from the hospital: (1) Loop diuretic. (2) Loop diuretic + distal tubule (antialdosterone ± thiazides). (3) Loop diuretic + distal + proximal tubule (acetazolamide ± SGLT2 inhibitor). (4) Loop diuretic + distal tubule + collecting duct (tolvaptan). (5) Loop diuretic + distal + proximal + collecting duct. Based on these diuretic combinations, profiles with clinical, analytical, and echocardiographic differences were established.
There were more previous hospitalizations in groups 4 and 5 (p = 0.001) with a predominance of pulmonary congestion in profiles 1 and 2 and systemic congestion in 3, 4, and 5. Creatinine and CA125 were higher in profiles 4 and 5 (p = 0.01 and p = 0.0001), with no differences in NT-proBNP. Profiles 4 and 5 had a higher proportion of dilatation and depression of right ventricular (p = 0.0001) and left ventricular (p = 0.003) function. Diuretic therapy-defined groups showed difference in clinical characteristics.
The diuretic treatment used identifies five clinical profiles according to the degree of congestion, renal function, CA125, and right ventricular functionality. These profiles would guide the best diuretic treatment on admission.
尽管有多种治疗手段，但心力衰竭（HF）中充血的治疗仍是一项挑战。本研究的目的是分析用于解决失代偿性HF患者充血问题的不同利尿剂组合，并根据这些治疗方法确定临床特征。
对2016年至2020年间收治的1559例失代偿性HF患者进行单中心研究。根据导致临床稳定和出院的利尿剂组合对患者进行分组：（1）袢利尿剂。（2）袢利尿剂+远曲小管（抗醛固酮剂±噻嗪类）。（3）袢利尿剂+远曲小管+近曲小管（乙酰唑胺±钠-葡萄糖协同转运蛋白2抑制剂）。（4）袢利尿剂+远曲小管+集合管（托伐普坦）。（5）袢利尿剂+远曲小管+近曲小管+集合管。基于这些利尿剂组合，建立了具有临床、分析和超声心动图差异的特征。
第4组和第5组既往住院次数更多（p = 0.001），第1组和第2组以肺充血为主，第3、4和5组以体循环充血为主。第4组和第5组的肌酐和CA125较高（p = 0.01和p = 0.0001），N末端B型利钠肽原无差异。第4组和第5组右心室（p = 0.0001）和左心室（p = 0.003）功能扩张和降低的比例更高。利尿剂治疗定义的组在临床特征上存在差异。
所使用的利尿剂治疗根据充血程度、肾功能、CA125和右心室功能确定了五种临床特征。这些特征将指导入院时最佳的利尿剂治疗。
