Huang Dou, Lacombe Philip, Gulati Gaurav, Couper Gregory S, Kawabori Masashi, Upshaw Jenica N, Vest Amanda, DeNofrio David, Kiernan Michael S
Department of Medicine, Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
Cardiovascular Institute, Maine Medical Center, Portland, Maine.
JHLT Open. 2024 Mar 9;4:100082. doi: 10.1016/j.jhlto.2024.100082. eCollection 2024 May.
Diuretic responsiveness is associated with heart failure disease progression. Among patients with advanced heart failure, we hypothesized that decreased diuretic responsiveness and higher diuretic requirement are correlates of progressive right ventricular dysfunction and may help to risk stratify patients undergoing left ventricular assist device (LVAD) evaluation.
We performed a single-center, retrospective analysis of 147 patients undergoing LVAD implantation between 2014 and 2018. The primary outcome was early right heart failure (RHF) or death during the index hospital stay. Patients were stratified by tertiles of preoperative 24-hour diuretic dose within 72 hours of surgery.
The incidence of early RHF was higher in the highest-dose group (66.0%) compared to the medium- (41.3%) and low-dose groups (23.5%) ( < 0.001). Each 40 mg increase in intravenous furosemide dose was associated with a 6% increase in the risk of RHF, after adjusting for other known risk factors. The median ICU length of stay was 2 days longer for patients in the highest compared to low-dose group (7 vs 5 days, = 0.02). Mortality within 14 days post-op was numerically higher although not significantly different between the highest-dose group and the low-dose group (12.0% vs 5.9%, = 0.55). Six-month survival across diuretic dose tertiles was also not statistically different ( = 0.40).
We concluded that higher preoperative diuretic dose is associated with risk of early RHF following LVAD surgery. These data furthermore support the role of progressive right ventricular dysfunction on the development of cardiorenal disease and diuretic resistance.
利尿剂反应性与心力衰竭疾病进展相关。在晚期心力衰竭患者中，我们假设利尿剂反应性降低和利尿剂需求增加与进行性右心室功能障碍相关，并且可能有助于对接受左心室辅助装置（LVAD）评估的患者进行风险分层。
我们对2014年至2018年间接受LVAD植入的147例患者进行了单中心回顾性分析。主要结局是在索引住院期间发生早期右心衰竭（RHF）或死亡。患者根据手术72小时内术前24小时利尿剂剂量的三分位数进行分层。
与中等剂量组（41.3%）和低剂量组（23.5%）相比，高剂量组早期RHF的发生率更高（66.0%）（<0.001）。在调整其他已知风险因素后，静脉注射呋塞米剂量每增加40mg，RHF风险增加6%。与低剂量组相比，高剂量组患者的ICU中位住院时间长2天（7天对5天，=0.02）。尽管高剂量组和低剂量组术后14天内的死亡率在数值上更高，但差异无统计学意义（12.0%对5.9%，=0.55）。不同利尿剂剂量三分位数的6个月生存率也无统计学差异（=0.40）。
我们得出结论，术前利尿剂剂量较高与LVAD手术后早期RHF风险相关。这些数据进一步支持了进行性右心室功能障碍在心脏肾疾病发展和利尿剂抵抗中的作用。
