High-Output Heart Failure A 15-Year Experience
High-Output Heart Failure A 15-Year Experience
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DOI：
10.1016/j.jacc.2016.05.043
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发表时间：
2016-08-02
影响因子：
24
通讯作者：
Borlaug, Barry A.
中科院分区：
文献类型：
--
作者：
Reddy, Yogesh N. V.;Melenovsky, Vojtech;Borlaug, Barry A.
高输出量心力衰竭（HF）是一种不常见的心力衰竭原因，其特征尚不清楚。本研究旨在描述现代高输出量HF的病因、病理生理学、临床和血流动力学特征以及结局。方法我们对2000年至2014年期间转诊至马约诊所导管实验室进行血流动力学评估的所有连续患者进行回顾性分析。明确的HF，定义的Frawling标准，受试者进行了比较，控制相似的年龄和sex.Results高输出HF（n = 120）最常见的病因是肥胖（31%），肝脏疾病（23%），动静脉分流（23%），肺部疾病（16%），和骨髓增生性疾病（8%）。与对照组（n = 24）相比，尽管射血分数相似，但高输出量HF受试者显示偏心性左心室重构、更大的利钠肽激活、更高的充盈压、肺动脉高压和心输出量增加。高输出量HF患者的心输出量升高与较低的动脉后负荷（全身血管阻力降低）和较高的代谢率有关。与对照组相比，高输出量HF的死亡率增加（风险比：3.4; 95%置信区间：1.6至7.6）。血液动力学和结果最差的患者之间的最低全身血管resistance.CONCLUSIONS高输出HF是一个重要的原因，临床HF在现代的过度血管扩张，最常见的肥胖，动静脉分流，肝脏疾病。鉴于这些合并症在西方国家的高死亡率和日益增加的患病率，在对出现呼吸困难、充血和射血分数正常的患者进行鉴别诊断时，必须考虑高输出量HF。(C)2016年由美国心脏病学会基金会。
BACKGROUND High-output heart failure (HF) is an unusual cause of cardiac failure that has not been well-characterized. OBJECTIVES This study sought to characterize the etiologies, pathophysiology, clinical and hemodynamic characteristics, and outcomes of high-output HF in the modern era.METHODS We performed a retrospective analysis of all consecutive patients referred to the Mayo Clinic catheterization laboratory for hemodynamic assessment between 2000 and 2014. Subjects with definite HF, as defined by the Framingham criteria, were compared to controls of similar age and sex.RESULTS The most common etiologies of high-output HF (n = 120) were obesity (31%), liver disease (23%), arteriovenous shunts (23%), lung disease (16%), and myeloproliferative disorders (8%). Compared with controls (n = 24), subjects with high-output HF displayed eccentric left ventricular remodeling, greater natriuretic peptide activation, higher filling pressures, pulmonary hypertension, and increased cardiac output, despite similar ejection fraction. Elevated cardiac output in high-output HF patients was related to both lower arterial afterload (decreased systemic vascular resistance) and higher metabolic rate. Mortality was increased in high-output HF as compared with controls (hazard ratio: 3.4; 95% confidence interval: 1.6 to 7.6). Hemodynamics and outcomes were poorest amongst patients with the lowest systemic vascular resistance.CONCLUSIONS High-output HF is an important cause of clinical HF in the modern era that is related to excessive vasodilation, and most frequently caused by obesity, arteriovenous shunts, and liver disease. Given the high mortality and increasing prevalence of these comorbidities in Western countries, high-output HF must be considered in the differential diagnosis of patients presenting with dyspnea, congestion, and a normal ejection fraction. (C) 2016 by the American College of Cardiology Foundation.