门诊慢性心力衰竭患者袢利尿剂剂量强化轨迹的预后意义
Prognostic implication of outpatient loop diuretic dose intensification trajectories in patients with chronic heart failure.
作者信息
Koike Toshiharu, Suzuki Atsushi, Kikuchi Noriko, Yoshimura Asami, Haruki Kaoru, Yoshida Ayano, Sone Maiko, Nakazawa Mayui, Tsukamoto Kei, Imamura Yasutaka, Hattori Hidetoshi, Kogure Tomohito, Yamaguchi Junichi, Shiga Tsuyoshi
机构信息
Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan.
出版信息
Int J Cardiol Heart Vasc. 2025 Mar 3;57:101632. doi: 10.1016/j.ijcha.2025.101632. eCollection 2025 Apr.
BACKGROUND
The relationship between outpatient oral loop diuretic (OLD) dose intensification trajectories and the prognosis of patients with chronic heart failure (CHF) remains unclear.
METHODS
In 832 patients with CHF, OLD dose trajectories for 1 year were consecutively investigated. OLD dose intensification was defined as the first occurrence of OLD dose increase from the baseline within the first year. Patients were classified into three groups of OLD dose intensification trajectories: irreversible, reversible, and no intensification. Irreversible intensification was defined as an OLD dose intensification wherein the dose remained above the baseline during the first year of follow-up. Reversible intensification referred to an OLD dose intensification wherein the dose returned to or dropped below the baseline within the first year of follow-up. No intensification was defined as no OLD dose intensification throughout the first year of follow-up. The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular death (CVD), heart failure hospitalisation (HFH), a composite of CVD or HFH, and a composite of all-cause mortality or HFH after 1 year.
RESULTS
During the median follow-up (57 [range, 13-102] months), 146 patients died. Irreversible intensification was associated with higher risks of all outcomes than no intensification (e.g., all-cause mortality: hazard ratio [HR], 1.63; 95% confidence interval [CI], 1.08-2.44; HFH: HR, 2.16; 95% CI, 1.65-2.98; CVD or HFH: HR, 2.17; 95% CI, 1.59-2.96). Conversely, reversible intensification had comparable prognoses for all outcomes to no intensification.
CONCLUSION
OLD dose intensification trajectories could stratify the prognosis of CHF patients.
背景
门诊口服袢利尿剂（OLD）剂量强化轨迹与慢性心力衰竭（CHF）患者预后之间的关系尚不清楚。
方法
连续调查了832例CHF患者1年的OLD剂量轨迹。OLD剂量强化定义为在第一年中首次出现OLD剂量从基线水平增加。患者被分为OLD剂量强化轨迹的三组：不可逆、可逆和无强化。不可逆强化定义为OLD剂量强化，其中在随访的第一年中剂量保持高于基线水平。可逆强化是指OLD剂量强化，其中剂量在随访的第一年内恢复到或降至基线水平以下。无强化定义为在随访的第一年中无OLD剂量强化。主要结局是全因死亡率。次要结局是心血管死亡（CVD）、心力衰竭住院（HFH）、CVD或HFH的复合结局以及1年后全因死亡率或HFH的复合结局。
结果
在中位随访期（57 [范围，13 - 102]个月）内，146例患者死亡。与无强化相比，不可逆强化与所有结局的较高风险相关（例如，全因死亡率：风险比[HR]，1.63；95%置信区间[CI]，1.08 - 2.44；HFH：HR，2.16；95% CI，1.65 - 2.98；CVD或HFH：HR，2.17；95% CI，1.59 - 2.96）。相反，可逆强化与无强化相比，所有结局的预后相当。
结论
OLD剂量强化轨迹可对CHF患者的预后进行分层。
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