Congestion and Decongestion Assessment in Heart Failure: Pressure, Volume, or Both?
Congestion and Decongestion Assessment in Heart Failure: Pressure, Volume, or Both?
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心力衰竭的充血和减充血评估：压力、容量或两者兼而有之？
DOI：
10.1016/j.jchf.2023.05.034
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Testani,JeffreyM
中科院分区：
文献类型：
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作者：
Biegus,Jan;Borlaug,BarryA;Testani,JeffreyM
中枢血流动力学异常（包括心内压升高）、神经激素激活和组织充血是心力衰竭（HF）患者症状和器官功能障碍的主要原因。 1 血流动力学紊乱和控制离子水稳态能力下降之间存在紧密的双向相互作用，这进一步加剧和加剧了临床表现和心力衰竭进展。充血是一个广泛的临床术语，描述了至少 2 个不同的过程：血流动力学充血（全身和肺静脉压力和容量升高）和组织充血（组织中多余的水积聚或水肿）。除了心脏功能障碍外，血流动力学充血很大程度上由两种主要机制决定：血管内容量扩张和血管张力。一些研究表明，在失代偿性心力衰竭住院之前，体重会显着增加（用作体液蓄积的替代指标），但体重波动作为充血和充血缓解标志的诊断准确性较差。 2, 3 此外，在没有可检测到的体重增加的情况下，住院前经常会出现血管内压显着升高。随着血流动力学充血恶化（例如静脉压升高），组织充血（例如水肿）平均会增加，但患者内部和患者之间的关系因胶体渗透压、毛细血管通透性和淋巴引流等多种因素而异。尽管存在这种复杂性，但准确评估整体充血状态显然对于心力衰竭至关重要，这为我们在床边做出的许多治疗决策奠定了基础。
Abnormal central hemodynamics (including elevated intracardiac pressures), neurohormonal activation, and tissue congestion are major causes of symptoms and organ dysfunction in patients with heart failure (HF). 1 There is a tight bidirectional interplay between hemodynamic disturbances and diminished abilities to control ion-water homeostasis, which further contributes to and escalates the clinical manifestation and HF progression. Congestion is a broad clinical term that describes at least 2 different processes: hemodynamic congestion (elevated systemic and pulmonary venous pressures and volumes) and tissue congestion (accumulation of excess water in tissues, or edema). In addition to cardiac dysfunction, hemodynamic congestion is largely determined by 2 primary mechanisms: intravascular volume expansion and vascular tone. Significant weight gain (used as a surrogate of fluid accumulation) has been shown to precede hospitalization for decompensated HF in some studies, but the diagnostic accuracy of the body weight fluctuations as a marker of both congestion and decongestion is poor. 2, 3 Furthermore, a significant increase in intravascular pressure precedes hospitalization frequently in the absence of detectable weight gain. Tissue congestion (eg, edema) on average will increase as hemodynamic congestion worsens (eg, elevation of venous pressures), but the relationship varies within and between patients based on a number of factors including oncotic pressures, capillary permeability, and lymphatic drainage. Despite this complexity, accurate assessment of overall congestion status is obviously of paramount importance in HF, forming the foundation for many of our therapeutic decisions at the bedside.