目的:急性心力衰竭(AHF)的残余充血与不良预后相关。然而,在对院内充血的综合评估中,缺乏有关变化的预后价值的数据.本研究试图根据左心室射血分数(LVEF)分类评估院内充血变化与随后预后之间的关联。
结果:患者(N=244,80.3±7.6年,50.8%男性)在两个欧洲三级护理中心因急性HF入院接受临床评估(充血评分包括休息时呼吸困难,罗尔斯,第三心音,颈静脉扩张,外周水肿,和肝肿大;简化的充血评分包括啰音和外周水肿),超声心动图,肺超声,入院和出院时的利钠肽(NP)测量。主要结局是全因死亡率和/或HF再住院的复合结果。在考虑的244例患者中(95例HF,EF降低,57HF,EF轻度降低,和92HF,保留EF),临床充血评分改善有限的患者(风险比2.33,95%CI1.51-3.61,P=0.0001),NP水平(2.29,95%CI1.55-3.38,P<0.0001),和B线数量(6.44,95%CI4.19-9.89,P<0.001)相比,患者出现更大规模的去充症的结果风险明显更高。当调整混杂因素时,观察到相同的关联模式。临床充血评分和B线数量的有限改善与所有LVEF类别的不良预后有关。
结论:在AHF中,在住院期间评估的充血减少程度可以对后续事件风险进行分层.临床充血和B线数量的有限减少与不良预后有关,无论HF亚型。
OBJECTIVE: Residual congestion in acute heart failure (AHF) is associated with poor prognosis. However, there is a lack of data on the prognostic value of changes in a combined assessment of in-hospital congestion. The present study sought to assess the association between in-hospital congestion changes and subsequent prognosis according to left ventricular ejection fraction (LVEF) classification.
RESULTS: Patients (N = 244, 80.3 ± 7.6 years, 50.8% male) admitted for acute HF in two European tertiary care centres underwent clinical assessment (congestion score included dyspnoea at rest, rales, third heart sound, jugular venous distention, peripheral oedema, and hepatomegaly; simplified congestion score included rales and peripheral oedema), echocardiography, lung ultrasound, and natriuretic peptides (NP) measurement at admission and discharge. The primary outcome was a composite of all-cause mortality and/or HF re-hospitalization. In the 244 considered patients (95 HF with reduced EF, 57 HF with mildly reduced EF, and 92 HF with preserved EF), patients with limited improvement in clinical congestion score (hazard ratio 2.33, 95% CI 1.51-3.61, P = 0.0001), NP levels (2.29, 95% CI 1.55-3.38, P < 0.0001), and the number of B-lines (6.44, 95% CI 4.19-9.89, P < 0.001) had a significantly higher risk of outcome compared with patients experiencing more sizeable decongestion. The same pattern of association was observed when adjusting for confounding factors. A limited improvement in clinical congestion score and in the number of B-lines was related to poor prognosis for all LVEF categories.
CONCLUSIONS: In AHF, the degree of congestion reduction assessed over the in-hospital stay period can stratify the subsequent event risk. Limited reduction in both clinical congestion and B-lines number are related to poor prognosis, irrespective of HF subtype.