Ponikowska Barbara, Zymliński Robert, Fudim Marat, Ponikowska Beata, Iwanek Gracjan, Guzik Mateusz, Biegus Jan
Department of Physiology and Pathophysiology, Wroclaw Medical University, Wroclaw, Poland.
Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
Eur J Heart Fail. 2025 Jun;27(6):1136-1144. doi: 10.1002/ejhf.3655. Epub 2025 Apr 7.
The dysfunctional lymphatic system appears to play an important role in the development and progression of congestion in heart failure. We hypothesized that in acute heart failure (AHF), diuretic efficacy is associated with peripheral lymph flow.
We prospectively studied AHF patients who received protocolized diuretics followed by assessment of lower limb flow using indocyanine green lymphangiography (a validated method for visualization of lymphatic drainage). The lymph flow was defined as 'present' when it reached the ankle and 'significant' when it reached >10 cm within 10 min of dye injection, respectively. Based on diuretic efficacy (defined as cumulative diuresis and weight loss), patients were classified as diuretic responders vs. non-responders. Overall, 65 patients (mean age: 67 ± 15 years, median [Q1-Q3] N-terminal pro-B-type natriuretic peptide: 6901 [4478-12 723] pg/ml) were examined. There were 43 (66%) diuretic responders and 22 (34%) non-responders who did not differ in baseline clinical/laboratory characteristics. Among the responders, there were more patients with lymph flow either 'present' or 'significant' (95% vs. 73% and 88% vs. 45% vs non-responders, respectively, p < 0.01). Responders had significantly longer median distance lymph reached within 10 min (50 [24-75] vs. 10 [3-38] cm; p < 0.0005). There was a significant association between lymph flow and 6-h diuresis with β (standard error) of 0.45 (0.13) (p < 0.005). In the multivariable analyses, lymph flow distance (odds ratio 1.48, 95% confidence interval 1.08-2.03) independently predicted diuretic efficacy (p < 0.05).
For the first time, faster lower limb lymph flow was linked with better diuretic efficacy in AHF. Studies are needed to determine whether the lymphatic system can become a therapeutic target for decongestion.
功能失调的淋巴系统似乎在心力衰竭充血的发生和发展中起重要作用。我们假设在急性心力衰竭（AHF）中，利尿剂疗效与外周淋巴液流动有关。
我们前瞻性地研究了接受标准化利尿剂治疗的AHF患者，随后使用吲哚菁绿淋巴管造影术评估下肢淋巴液流动情况（一种用于可视化淋巴引流的有效方法）。淋巴液流动在染料注射后10分钟内到达脚踝时定义为“存在”，到达超过10厘米时定义为“显著”。根据利尿剂疗效（定义为累积尿量和体重减轻），将患者分为利尿剂反应者和无反应者。总体而言，共检查了65例患者（平均年龄：67±15岁，中位数[Q1-Q3]N末端B型利钠肽原：6901[4478-12723]pg/ml）。有43例（66%）利尿剂反应者和22例（34%）无反应者，他们在基线临床/实验室特征方面无差异。在反应者中，有更多患者的淋巴液流动“存在”或“显著”（分别为95%对73%和88%对45%，与无反应者相比，p<0.01）。反应者在10分钟内淋巴液到达的中位数距离显著更长（50[24-75]对10[3-38]厘米；p<0.0005）。淋巴液流动与6小时尿量之间存在显著关联，β（标准误差）为0.45（0.13）（p<0.005）。在多变量分析中，淋巴液流动距离（比值比1.48，95%置信区间1.08-2.03）独立预测利尿剂疗效（p<0.05）。
首次发现AHF中更快的下肢淋巴液流动与更好的利尿剂疗效相关。需要开展研究以确定淋巴系统是否可成为充血治疗的靶点。
