Łagosz Piotr, Biegus Jan, Lewandowski Łukasz, Ponikowski Piotr, Zymliński Robert
Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland.
Institute of Heart Diseases, University Clinical Hospital, Wrocław, Poland.
Kardiol Pol. 2024;82(3):292-302. doi: 10.33963/v.phj.99497. Epub 2024 Mar 17.
Intra-abdominal pressure (IAP) is a frequently overlooked aspect in clinical assessment that can have a significant impact on organ dysfunction in patients with acute decompensated heart failure (ADHF).
We aimed to investigate dynamics of IAP in patients with ADHF and its impact on diuretic response.
We conducted a prospective observational pilot study on a group consisting of 30 patients admitted for ADHF. In every individual IAP measurement, blood and urine samples were taken upon admission, on the second and third days of hospitalization.
The study showed a high (63.3%) prevalence of intra-abdominal hypertension (IAH) defined as IAP ≥12 mm Hg upon admission, while only roughly 13% had signs of ascites. We observed poorer diuresis on the first day of hospitalization in the IAH group (P = 0.03). IAP was negatively correlated with urine output (P = 0.01) and positively correlated with urine osmolality (P = 0.03) on the first day of hospitalization. During follow-up, there was a significant decrease in IAP in patients with IAH upon admission who received standard decongestive therapy.
The study shows a high prevalence of IAH in patients admitted for ADHF, even in individuals who do not present symptoms of abdominal congestion. Established correlation between IAP, reduced diuresis, and increased urine osmolality, despite achieving target natriuresis, contributes novel insights into the understanding of pathomechanisms underlying diuretic resistance in ADHF.
腹内压（IAP）是临床评估中一个经常被忽视的方面，它对急性失代偿性心力衰竭（ADHF）患者的器官功能障碍可能产生重大影响。
我们旨在研究ADHF患者的IAP动态变化及其对利尿剂反应的影响。
我们对30例因ADHF入院的患者进行了一项前瞻性观察性试点研究。在每次测量IAP时，入院时、住院第二天和第三天采集血液和尿液样本。
研究显示，入院时腹内高压（IAH）（定义为IAP≥12mmHg）的患病率很高（63.3%），而只有约13%有腹水迹象。我们观察到IAH组住院第一天的利尿效果较差（P = 0.03）。住院第一天，IAP与尿量呈负相关（P = 0.01），与尿渗透压呈正相关（P = 0.03）。在随访期间，入院时患有IAH且接受标准去充血治疗的患者IAP显著下降。
该研究表明，因ADHF入院的患者中IAH的患病率很高，即使在没有腹部充血症状的个体中也是如此。尽管达到了目标利钠效果，但IAP、利尿减少和尿渗透压增加之间已确立的相关性为理解ADHF中利尿剂抵抗的病理机制提供了新的见解。
