Nagao Kazuya, Kato Takao, Yaku Hidenori, Morimoto Takeshi, Aida Kenji, Maruichi Shiori Kawakami, Inuzuka Yasutaka, Tamaki Yodo, Yamamoto Erika, Yoshikawa Yusuke, Kitai Takeshi, Taniguchi Ryoji, Iguchi Moritake, Kato Masashi, Takahashi Mamoru, Jinnai Toshikazu, Kawai Takafumi, Komasa Akihiro, Nishikawa Ryusuke, Kawase Yuichi, Morinaga Takashi, Su Kanae, Kawato Mitsunori, Seko Yuta, Inada Tsukasa, Inoko Moriaki, Toyofuku Mamoru, Furukawa Yutaka, Nakagawa Yoshihisa, Ando Kenji, Kadota Kazushige, Shizuta Satoshi, Sato Yukihito, Kuwahara Koichiro, Ozasa Neiko, Ono Koh, Kimura Takeshi
Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan.
Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Card Fail. 2025 Jun;31(6):912-924. doi: 10.1016/j.cardfail.2024.08.060. Epub 2024 Sep 30.
Most patients hospitalized for heart failure (HF) present with signs of congestion. Prognostic significance of clinical congestion may vary depending on left ventricular ejection fraction (LVEF). This study aims to investigate the prognostic impact of congestion across different LVEF categories.
Composite congestion scores (CCSs; 0-9) derived from the severity of edema, jugular venous pressure, and orthopnea, were analyzed on admission and at discharge in 3787 patients hospitalized for HF (LVEF ≥ 40%: n = 2347, LVEF < 40%: n = 1440). The median admission CCS was 4 in both LVEF strata (P = .64). Adjusted hazard ratios (HRs; 95% confidence interval [CI]) of the moderate (CCS 4-6) and severe congestion [7-9] groups relative to the mild congestion [0-3] group on admission for a composite of all-cause death or HF rehospitalization were 1.20 (1.04-1.39, P = .01) and 1.54 (1.27-1.86, P < .001) in the LVEF ≥ 40% stratum, and 1.20 (1.01-1.44, P = .04) and 0.82 (0.61-1.07, P = .14) in the LVEF < 40% stratum, respectively (P< .001). A total of 16% of the patients with LVEF ≥40% and 14% with LVEF <40% had residual congestion (CCS ≥ 1) at discharge, which was associated with a respective adjusted HR of 1.40 (1.18-1.65, P < .001) and 1.25 (0.98-1.58, P = .07) for postdischarge death or HF rehospitalization (P = 0.63).
The severity of clinical congestion on admission was associated with adverse clinical outcomes in patients with LVEF ≥ 40%, but not in those with LVEF < 40%. These findings warrant further studies to better understand the detailed profile of congestion across the LVEF spectrum.
大多数因心力衰竭（HF）住院的患者都有充血体征。临床充血的预后意义可能因左心室射血分数（LVEF）而异。本研究旨在探讨不同LVEF类别中充血的预后影响。
对3787例因HF住院的患者（LVEF≥40%：n = 2347，LVEF<40%：n = 1440）入院时和出院时的综合充血评分（CCSs；0 - 9）进行分析，该评分由水肿严重程度、颈静脉压和端坐呼吸得出。两个LVEF分层中入院时的CCS中位数均为4（P = 0.64）。入院时，LVEF≥40%分层中，中度（CCS 4 - 6）和重度充血[7 - 9]组相对于轻度充血[0 - 3]组的全因死亡或HF再住院综合调整风险比（HRs；95%置信区间[CI]）分别为1.20（1.04 - 1.39，P = 0.01）和1.54（1.27 - 1.86，P < 0.001）；LVEF<40%分层中分别为1.20（1.01 - 1.44，P = 0.04）和0.82（0.61 - 1.07，P = 0.14）（P < 0.001）。LVEF≥40%的患者中有16%、LVEF<40%的患者中有14%在出院时仍有残余充血（CCS≥1），这与出院后死亡或HF再住院的调整后HR分别为分别为1.40（1.18 - 1.65，P < 0.001）和1.25（0.98 - 1.58，P = 0.07）相关（P = 0.63）。
入院时临床充血的严重程度与LVEF≥40%的患者不良临床结局相关，但与LVEF<40%的患者无关。这些发现值得进一步研究，以更好地了解整个LVEF范围内充血的详细情况。
