Prognostic Value of the Physical Examination in Patients With Heart Failure and Atrial Fibrillation
Prognostic Value of the Physical Examination in Patients With Heart Failure and Atrial Fibrillation
复制标题
DOI：
10.1016/j.jchf.2013.10.004
复制
发表时间：
2014-02-01
影响因子：
13
通讯作者：
Ducharme, Anique
中科院分区：
文献类型：
--
作者：
Caldentey, Guillem;Khairy, Paul;Ducharme, Anique
目的本研究旨在评估现代治疗心力衰竭population.Background的体格检查的预后价值的评价和监测心力衰竭患者的体格检查的基石。然而，充血性体征的预后价值（即，外周水肿、颈静脉扩张、第三心音和肺部罗音）在当前时代还没有被评估。方法对所有1,376例患者进行事后分析，81%为男性，平均年龄67 ± 11岁，有症状的左心室收缩功能障碍，参加了AF-CHF（房颤和充血性心力衰竭）试验。结果外周水肿425例（30.9%），颈静脉扩张297例（21.6%），第三心音207例（15.0%），肺部罗音178例（12.9%）。在平均37 +/- 19个月的随访中，357例（25.9%）患者发生心血管原因死亡。在单变量分析中，所有4项体格检查结果均与心血管死亡率相关（所有p值均< 0.01）。在多变量分析中，将所有4个体征作为潜在协变量，只有罗音（风险比1.41; 95%置信区间：1.07 - 1.86; p = 0.013）和外周水肿（风险比：1.25; 95%置信区间：1.00至1.57; p = 0.048）与心血管死亡率相关，与其他变量无关。外周水肿、颈静脉扩张、第三心音和肺部罗音）继续为充血性心力衰竭患者提供重要的预后信息。(C)2014年美国心脏病学会基金会
Objectives This study sought to assess the prognostic value of physical examination in a modern treated heart failure population.Background The physical examination is the cornerstone of the evaluation and monitoring of patients with heart failure. Yet, the prognostic value of congestive signs (i.e., peripheral edema, jugular venous distension, a third heart sound, and pulmonary rales) has not been assessed in the current era.Methods A post-hoc analysis was conducted on all 1,376 patients, 81% male, mean age 67 +/- 11 years, with symptomatic left ventricular systolic dysfunction enrolled in the AF-CHF (Atrial Fibrillation and Congestive Heart Failure) trial. The prognostic value of baseline physical examination findings was assessed in univariate and multivariate Cox regression analyses.Results Peripheral edema was observed in 425 (30.9%), jugular venous distension in 297 (21.6%), a third heart sound in 207 (15.0%), and pulmonary rales in 178 (12.9%) patients. Death from cardiovascular causes occurred in 357 (25.9%) patients over a mean follow-up of 37 +/- 19 months. All 4 physical examination findings were associated with cardiovascular mortality in univariate analyses (all p values < 0.01). In multivariate analyses, taking all 4 signs as potential covariates, only rales (hazard ratio 1.41; 95% confidence interval: 1.07 to 1.86; p = 0.013) and peripheral edema (hazard ratio: 1.25; 95% confidence interval: 1.00 to 1.57; p = 0.048) were associated with cardiovascular mortality, independent of other variables.Conclusions In the modern era, congestive signs on the physical examination (i.e., peripheral edema, jugular venous distension, a third heart sound, and pulmonary rales) continue to provide important prognostic information in patients with congestive heart failure. (C) 2014 by the American College of Cardiology Foundation