Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure
Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure
复制标题
DOI：
10.1016/s0735-1097(03)00309-7
复制
发表时间：
2003-05-21
影响因子：
24
通讯作者：
Stevenson, LW
中科院分区：
文献类型：
--
作者：
Nohria, A;Tsang, SW;Stevenson, LW
目的 本研究旨在确定所提议的晚期心力衰竭 (HF) 分类的相关性。将基于住院时充血和灌注临床评估的概况与随后的结果进行比较。 背景 由于缺乏简单的临床概况来表征患者，晚期心力衰竭治疗和试验的最佳设计仍然受到限制。 方法 对 452 名入住布莱根妇女医院心肌病服务并诊断为心力衰竭的患者进行前瞻性分析。根据临床评估将患者分为四种情况： A 型患者，没有充血或灌注不足的证据（干热，n = 123）； B 型，充分灌注充血（湿热，n = 222）； C 型，充血和灌注不足（湿冷，n = 91）；和 L 型，灌注不足但无充血（干冷，n = 16）。其他标准的结果预测因素也包括在内，并对患者一年后的死亡终点 (n = 117) 和死亡或紧急移植 (n = 137) 进行随访。 结果 生存分析显示，临床特征可预测心力衰竭的结果。根据单变量（风险比 [HR] 1.83，p = 0.02）和多变量分析（HR 2.48，p = 0.003），曲线 B 和 C 增加了死亡加紧急移植的风险。此外，即使仅限于纽约心脏协会 (NYHA) III/IV 级症状的患者，临床特征也可以增加预后信息（特征 B：HR 2.23，p = 0.026；特征 C：HR 2.73，p = 0.009）。 结论 简单的临床评估可用于定义因心力衰竭入院的患者特征。这些概况可预测结果，并可用于指导治疗并确定未来研究的人群。 (C) 2003 年由美国心脏病学会基金会资助。
OBJECTIVES This study was designed to determine the relevance of a proposed classification for advanced heart failure (HF). Profiles based on clinical assessment of congestion and perfusion at the time of hospitalization were compared with subsequent outcomes.BACKGROUND Optimal design of therapy and trials for advanced HF remains limited by the lack of simple clinical profiles to characterize patients.METHODS Prospective analysis was performed for 452 patients admitted to the cardiomyopathy service at the Brigham and Women's Hospital with a diagnosis of HF. Patients were classified by clinical assessment into four profiles: profile A patients with no evidence of congestion or hypoperfusion (dry-warm, n = 123); profile B, congestion with adequate perfusion (wet-warm, n = 222); profile C, congestion and hypoperfusion (wet-cold, n = 91); and profile L, hypoperfusion without congestion (dry-cold, n = 16). Other standard predictors of outcome were included and patients were followed for the end points of death (n = 117) and death or urgent transplantation (n = 137) at one year.RESULTS Survival analysis showed that clinical profiles predict outcomes in HF. Profiles B and C increase the risk of death plus urgent transplantation by univariate (hazard ratio [HR] 1.83, p = 0.02) and multivariate analyses (HR 2.48, p = 0.003). Moreover, clinical profiles add prognostic information even when limited to patients with New York Heart Association (NYHA) class III/IV symptoms (profile B: HR 2.23, p = 0.026; profile C: HR 2.73, p = 0.009).CONCLUSIONS Simple clinical assessment can be used to define profiles in patients admitted with HF. These profiles predict outcomes and may be used to guide therapy and identify populations for future investigation. (C) 2003 by the American College of Cardiology Foundation.