Cardiology Unit, 'Buon Consiglio' Fatebenefratelli Hospital, Naples, Italy.
Université de Lorraine, INSERM, Centre d'Investigations Cliniques 1433, CHRU de Nancy, Inserm 1116 and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, 4, rue du Morvan, 54500 Nancy, France.
Eur Heart J Cardiovasc Imaging. 2024 Jul 31;25(8):1127-1135. doi: 10.1093/ehjci/jeae075.
Residual congestion in acute heart failure (AHF) is associated with poor prognosis. However, there is a lack of data on the prognostic value of changes in a combined assessment of in-hospital congestion. The present study sought to assess the association between in-hospital congestion changes and subsequent prognosis according to left ventricular ejection fraction (LVEF) classification.
Patients (N = 244, 80.3 ± 7.6 years, 50.8% male) admitted for acute HF in two European tertiary care centres underwent clinical assessment (congestion score included dyspnoea at rest, rales, third heart sound, jugular venous distention, peripheral oedema, and hepatomegaly; simplified congestion score included rales and peripheral oedema), echocardiography, lung ultrasound, and natriuretic peptides (NP) measurement at admission and discharge. The primary outcome was a composite of all-cause mortality and/or HF re-hospitalization. In the 244 considered patients (95 HF with reduced EF, 57 HF with mildly reduced EF, and 92 HF with preserved EF), patients with limited improvement in clinical congestion score (hazard ratio 2.33, 95% CI 1.51-3.61, P = 0.0001), NP levels (2.29, 95% CI 1.55-3.38, P < 0.0001), and the number of B-lines (6.44, 95% CI 4.19-9.89, P < 0.001) had a significantly higher risk of outcome compared with patients experiencing more sizeable decongestion. The same pattern of association was observed when adjusting for confounding factors. A limited improvement in clinical congestion score and in the number of B-lines was related to poor prognosis for all LVEF categories.
In AHF, the degree of congestion reduction assessed over the in-hospital stay period can stratify the subsequent event risk. Limited reduction in both clinical congestion and B-lines number are related to poor prognosis, irrespective of HF subtype.
急性心力衰竭（AHF）患者仍存在淤血与预后不良相关。然而，目前尚缺乏有关住院期间淤血综合评估变化的预后价值的数据。本研究旨在根据左心室射血分数（LVEF）分类评估住院期间淤血变化与随后预后之间的关系。
在欧洲的两家三级护理中心，共纳入 244 名因急性 HF 入院的患者（年龄 80.3±7.6 岁，50.8%为男性），在入院和出院时进行临床评估（淤血评分包括静息时呼吸困难、啰音、第三心音、颈静脉扩张、外周水肿和肝肿大；简化淤血评分包括啰音和外周水肿）、超声心动图、肺部超声和利钠肽（NP）检测。主要结局是全因死亡和/或 HF 再入院的复合终点。在 244 名考虑入组的患者中（95 名射血分数降低性 HF、57 名射血分数轻度降低性 HF 和 92 名射血分数保留性 HF），临床淤血评分改善有限（危险比 2.33，95%CI 1.51-3.61，P=0.0001）、NP 水平（2.29，95%CI 1.55-3.38，P<0.0001）和 B 线数量（6.44，95%CI 4.19-9.89，P<0.001）改善较小的患者，其结局风险显著更高。在调整混杂因素后，也观察到了相同的关联模式。临床淤血评分和 B 线数量改善有限与所有 LVEF 类别的不良预后相关。
在 AHF 中，住院期间评估的淤血缓解程度可以对随后的事件风险进行分层。无论 HF 亚型如何，临床淤血和 B 线数量减少有限都与预后不良相关。
