A Novel Noninvasive Method to Assess Optimal Diuresis in Patients With Heart Failure
A Novel Noninvasive Method to Assess Optimal Diuresis in Patients With Heart Failure
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一种评估心力衰竭患者最佳利尿情况的新型无创方法
DOI：
10.1016/j.jchf.2018.10.021
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发表时间：
2019
影响因子：
13
通讯作者：
Geng Qingshan
中科院分区：
文献类型：
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作者：
Ma Huan;Huang Daozheng;Xue Ling;Wang Yu;Geng Qingshan
我们怀着极大的兴趣阅读了Strobeck等人的队列临床试验。（一）.作者清楚地表明，与倾向匹配的对照组相比，使用容量指导的心力衰竭（HF）治疗可以减少死亡和再住院。容量引导HF治疗的目标是总血容量（TBV）阈值，范围为高于患者特定标准值的6%至8%。TBV值通过使用碘-131标记的白蛋白指示剂稀释技术测量，该技术是评估TBV的金标准。使用这种方法，作者发现只有37%的患者，谁被认为是有容量超负荷的临床评估，实际上是高血容量根据血容量分析（BVA）。由于HF期间的液体重新分布，一些患者可能出现HF体征和症状，但TBV没有变化。BVA引导的治疗可能会忽略对静脉储血器和有效循环血量之间的变化的考虑。此外，该方法昂贵且具有侵入性，没有描述一致或标准化的治疗方案，BVA的重现性仍然值得怀疑。我们提出了一个类似的，但非侵入性和简单的方法来评估最佳TBV的HF患者间接。被动抬腿试验（PLRT）可能有助于准确预测患者的容量反应性（2，3）。PLRT是一种可逆的“前负荷挑战”，大约300 ml血液（4），可以根据需要频繁重复，无需输注一滴液体。如果在测试过程中患者的每搏输出量增加超过10%，则认为患者是容量反应性的，可以给予液体替代治疗以增加每搏输出量
It was with great interest that we read the cohort clinical trial by Strobeck et al.(1). The authors clearly show that using volume-guided heart failure (HF) therapy can reduce death and rehospitalization more than propensity-matched controls can. Volumeguided HF therapy targeted a total blood volume (TBV) threshold ranging from 6% to 8% above patient-specific normative values. TBV values were measured by using an iodine-131-labeled albumin indicator dilution technique, which is the gold standard for assessing TBV. Using that method, the authors found only 37% of patients, who were thought to have volume overload by clinical assessment, were actually hypervolemic according to blood volume analysis (BVA). Due to fluid redistribution during HF, some patients may present with HF signs and symptoms but without a change in TBV. BVA-guided treatment may overlook consideration of the shifts between the venous reservoir and the effective circulating blood volume. Additionally, the method is expensive and invasive, there are no consistent or standardized treatment protocol (s) described, and BVA reproducibility is still questionable. We propose a similar but noninvasive and simple method to assess optimal TBV in patients with HF indirectly. The passive leg-raising test (PLRT) may help accurately predict a patient’s volume responsiveness (2, 3). The PLRT is a reversible “preload challenge” of approximately 300 ml of blood (4) that can be repeated as frequently as required without infusing a drop of fluid. If the patient’s stroke volume increases by more than 10% during the test, the patient is considered to be volume reactive and can be given fluid replacement therapy to increase stroke volume