López-Vilella Raquel, Guerrero Cervera Borja, Donoso Trenado Víctor, Martínez Dolz Luis, Almenar Bonet Luis
Heart Failure and Transplant Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
Front Cardiovasc Med. 2024 May 21;11:1381514. doi: 10.3389/fcvm.2024.1381514. eCollection 2024.
In heart failure (HF), not all episodes of decompensation are alike. The study aimed to characterize the clinical groups of decompensation and perform a survival analysis.
A retrospective study was conducted on patients consecutively admitted for HF from 2018 to 2023. Patients who died during admission were excluded (final number 1,668). Four clinical types of HF were defined: low cardiac output (:83), pulmonary congestion (:1,044), mixed congestion (:353), and systemic congestion (:188).
The low output group showed a higher prevalence of reduced left ventricular ejection fraction (93%) and increased biventricular diameters ( < 0.01). The systemic congestion group exhibited a greater presence of tricuspid regurgitation with dilatation and right ventricular dysfunction (:0.0001), worse renal function, and higher uric acid and CA125 levels (:0.0001). Diuretics were more commonly used in the mixed and, especially, systemic congestion groups (:0.0001). The probability of overall survival at 5 years was 49%, with higher survival in pulmonary congestion and lower in systemic congestion (:0.002). Differences were also found in survival at 1 month and 1 year (:0.0001).
Mortality in acute HF is high. Four phenotypic profiles of decompensation differ clinically, with distinct characteristics and varying prognosis in the short, medium, and long term.
在心力衰竭（HF）中，并非所有失代偿发作都是相同的。本研究旨在对失代偿的临床分组进行特征描述并进行生存分析。
对2018年至2023年因HF连续入院的患者进行回顾性研究。排除入院期间死亡的患者（最终数量为1668例）。定义了四种HF临床类型：低心输出量（n = 83）、肺淤血（n = 1044）、混合性淤血（n = 353）和体循环淤血（n = 188）。
低输出量组左心室射血分数降低的患病率较高（93%），双心室直径增加（P < 0.01）。体循环淤血组三尖瓣反流伴扩张和右心室功能障碍的发生率更高（P = 0.0001），肾功能更差，尿酸和CA125水平更高（P = 0.0001）。利尿剂在混合性淤血组，尤其是体循环淤血组中更常用（P = 0.0001）。5年总生存率为49%，肺淤血组生存率较高，体循环淤血组生存率较低（P = 0.002）。在1个月和1年生存率方面也存在差异（P = 0.0001）。
急性HF的死亡率很高。四种失代偿表型在临床上有所不同，具有不同的特征，在短期、中期和长期预后也有所不同。
