Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Via Valdoni 7, 34149, Trieste, Italy.
Cardiac, Vascular, and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
ESC Heart Fail. 2024 Oct;11(5):3146-3154. doi: 10.1002/ehf2.14818. Epub 2024 Jun 13.
The use of loop diuretics in pulmonary arterial hypertension (PAH) is less frequent compared with heart failure. The clinical and prognostic characteristics of PAH patients according to loop diuretic use remain unexplored. In this study, we retrospectively analysed the characteristics and survival of PAH patients requiring different doses of loop diuretics.
Patients diagnosed with PAH between 2001 and 2022 at seven European centres for the management of PAH. According to the median equivalent dose of furosemide in the overall cohort, patients were divided into two subgroups: no/low-dose loop diuretic and high-dose loop diuretic. Primary outcome was 5 year all-cause mortality. Among the 397 patients included, 227 (57%) were treated with loop diuretics. Median daily furosemide equivalent dose was 25 mg, and accordingly patients were divided in no/low dose (i.e. ≤25 mg, n = 257, 65%) vs. high dose (i.e. >25 mg, n = 140, 35%). Patients in the high-dose group were older, more likely to have comorbidities, and had a more severe disease according to the ESC/ERS risk category. Crude 5 year survival was significantly shorter in patients in the high-dose group, but after adjustment for age, sex, and risk category, high loop diuretic dose was not significantly associated with the primary outcome.
Use of high dose of loop diuretics in PAH is associated with a higher burden of comorbidities, more severe disease, and worse survival. However, in PAH, the need of high loop diuretic dose is a marker of disease severity and not an independent prognostic factor.
与心力衰竭相比，在肺动脉高压（PAH）中使用袢利尿剂的频率较低。根据使用袢利尿剂，PAH 患者的临床和预后特征仍未得到探索。在这项研究中，我们回顾性分析了需要不同剂量袢利尿剂的 PAH 患者的特征和生存情况。
在七个欧洲 PAH 管理中心诊断为 PAH 的患者在 2001 年至 2022 年期间。根据整个队列中呋塞米的等效剂量中位数，将患者分为两组：无/低剂量袢利尿剂和高剂量袢利尿剂。主要结局是 5 年全因死亡率。在纳入的 397 例患者中，227 例（57%）接受了袢利尿剂治疗。呋塞米等效剂量的中位日剂量为 25mg，因此患者被分为无/低剂量（即≤25mg，n=257，65%）和高剂量（即>25mg，n=140，35%）。高剂量组的患者年龄较大，更有可能患有合并症，并且根据 ESC/ERS 风险类别，疾病更严重。高剂量组的患者 5 年生存率明显缩短，但在调整年龄、性别和风险类别后，高剂量袢利尿剂与主要结局无显著相关性。
在 PAH 中使用高剂量的袢利尿剂与更高的合并症负担、更严重的疾病和更差的生存相关。然而，在 PAH 中，高剂量袢利尿剂的需求是疾病严重程度的标志，而不是独立的预后因素。
