Symptoms in heart failure correlate poorly with objective haemodynamic parameters
Symptoms in heart failure correlate poorly with objective haemodynamic parameters
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DOI：
10.1111/j.1742-1241.2012.03003.x
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发表时间：
2012-12-01
影响因子：
2.6
通讯作者：
Darbinyan, N.
中科院分区：
文献类型：
--
作者：
Guglin, M.;Patel, T.;Darbinyan, N.
简介：尽管心力衰竭（HF）是一种非常常见的疾病，但令人惊讶的是，关于患者症状和客观数据之间的关联知之甚少。本研究的目的是评估HF患者的血流动力学、超声心动图和实验室数据之间的相关性。研究方法：本研究是对国家心肺血液研究所提供的充血性心力衰竭和肺动脉导管插入术有效性评价研究（ESCAPE）试验的有限访问数据集的回顾性分析。在入院时、出院时、入院后3个月和6个月时，根据症状的严重程度从最小（0）到最大（3）对症状（包括呼吸困难、端坐呼吸、疲乏和胃肠道（GI）不适）进行分级。在相同的时间点获得明尼苏达心力衰竭生活（MLHF）评分和指定的纽约心脏协会（NYHA）功能分级的结果。结果：共有433例失代偿性HF和收缩功能下降（射血分数< 30%）患者纳入本试验。直立呼吸、呼吸困难和疲劳与有创肺动脉收缩压和舒张压呈弱相关，与血清肌酐、白蛋白、钠、总胆红素、血红蛋白和红细胞压积呈负相关;疲劳与肺动脉压呈正相关。腹部不适与症状无相关性。症状、NYHA分级或MLHF评分与年龄、性别、心肺负荷试验的峰值VO 2、体重指数、右心室或左心室收缩功能、B型利钠肽、心输出量或心脏指数、肌钙蛋白水平、三尖瓣反流速度以及预测HF发病率和死亡率的多种其他因素无关。结论：总体而言，症状与客观参数之间的相关性较弱。由于症状与客观参数之间的关系程度较低，因此得出结论，可能存在其他因素决定HF患者的症状感知。
Introduction: Even though heart failure (HF) is a very common condition, surprisingly little is known regarding association between patients symptoms and objective data. The purpose of this study was to evaluate for any correlations between haemodynamic, echocardiographic and laboratory data of presenting symptoms in HF patients. Methods: This study is a retrospective analysis of the limited access dataset from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial provided by the National Heart, Lung and Blood Institute. Symptoms including dyspnoea, orthopnoea, fatigue and gastrointestinal (GI) discomfort were graded by their severity from minimal (0) to maximal (3) on admission, at discharge, at 3 months and at 6 months from the admission. Results of Minnesota Living with Heart Failure (MLHF) score and assigned New York Heart Association (NYHA) functional class were available at the same time points. Results: A total of 433 patients with decompensated HF and decreased systolic function (ejection fraction < 30%) were included in this trial. Orthopnoea, dyspnoea and fatigue had weak correlation with invasive pulmonary artery systolic and diastolic pressure and negative correlation with serum creatinine, albumin, sodium, total bilirubin, haemoglobin and haematocrit; fatigue showed positive correlation to pulmonary artery pressures. Abdominal discomfort had no correlation to symptoms. There was no correlation of symptoms, NYHA class, or MLHF scores with age, gender, peak VO2 on cardiopulmonary stress test, body mass index, either right or left ventricular systolic function, B-type natriuretic peptide, cardiac output or cardiac index, troponin level, velocity of tricuspid regurgitation and multiple other factors predicting morbidity and mortality in HF. Conclusion: Overall, the correlation between symptoms and objective parameters was weak. Because of low magnitude of relationship between symptoms to objective parameters, it was concluded that there are likely other factors determining the perception of symptoms in HF patients.