心衰患者静脉充血的床边超声评估:临床关联和预后价值

Zh. D. Kobalava, R. Sh. Aslanova, A. F. Safarova, M. V. Vatsik-Gorodetskaya
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摘要

的目标。目的:评价失代偿性心力衰竭(HF)患者床边超声静脉充血的频率、动态、临床相关性及预后价值。材料和方法。这项前瞻性研究纳入273例18岁以上NYHA II-IV级失代偿性心衰患者。所有患者都进行了标准的临床和临床旁分析,包括NT-proBNP测定、瞬态弹性测量和肺部超声。采用VExUS方案床边超声评估静脉充血,估计下腔静脉(IVC)直径,根据肝、门、肾静脉多普勒曲线偏差判断充血严重程度。如果下腔静脉直径≥2sm,则判定静脉充血。对肺充血进行评估时,按8区方案行肺超声(LUS)检查,以b线≥5条之和为肺充血。所有患者均接受心力衰竭的标准治疗。采用SPSS统计软件26.0进行统计分析。结果。根据VExUS方案,失代偿性HF患者入院时床边超声检查显示静脉充血的检出率很高(75,8%):轻度为35,5%,中度为12,8%,重度为27,5%。出院时静脉充血的检出率为48.7%:轻度为28.2%,中度为9.5%,重度为11.0%。入院时肺充血率为98.9%。静脉充血与HF严重程度、NT-proBNP水平、肾功能和心功能障碍、肝脏僵硬度和b线总和相关。根据VExUS方案确定静脉充血对失代偿性HF再住院的预后作用以及12个月时的联合终点(失代偿性HF住院+全因死亡)。结论。失代偿性心衰患者静脉充血的发生率、相关性和预后价值表明,床边超声使用VExUS方案作为一种可用的无创方法来优化治疗和风险分层。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Bedside ultrasound assessment of venous congestion by VExUS protocol in heart failure: clinical associations and prognostic value
Aim. To evaluate the frequency, dynamics, clinical associations and prognostic value of venous congestion at bedside ultrasound using VExUS protocol in patients with decompensated heart failure (HF). Material and methods . This prospective study included 273 patients over 18 years old with NYHA class II-IV decompensated HF. All patients underwent standard clinical and paraclinical analysis, including NT-proBNP determination, transient elastometry and lung ultrasound. To assess venous congestion by bedside ultrasound using the VExUS protocol, the inferior vena cava (IVC) diameter was estimated and the congestion severity was determined on the deviation of Doppler curves of hepatic, portal and renal veins. If the IVC diameter was ≥2 sm, venous congestion was determined. To assess pulmonary congestion, lung ultrasound (LUS) was performed according to the 8-zone protocol, and the sum of B-lines ≥5 was taken as pulmonary congestion. All patients received standard therapy for heart failure. Statistical analysis was performed in SPSS Statistics program, version 26.0. Results . A high detection rate of venous congestion (75,8%) was revealed in patients with decompensated HF on admission at bedside ultrasound examination according to the VExUS protocol: mild – in 35,5%, moderate – in 12,8%, severe – in 27,5% of patients. The detection rate of venous congestion at discharge was 48,7%: mild – in 28,2%, moderate – in 9,5%, and severe – in 11,0% of cases. Pulmonary congestion on admission was detected in 98,9% of cases. Venous congestion was associated with the severity of HF, NT-proBNP level, renal and cardiac dysfunction, liver stiffness and sum of B-lines. The prognostic role of venous congestion according to the VExUS protocol on re-hospitalization for decompensated HF and the combined endpoint (hospitalization for decompensated HF + allcause death) at 12 months was established. Conclusion . The established incidence, associations, and prognostic value of venous congestion in patients with decompensated HF suggest the utility of bedside ultrasound using the VExUS protocol as an available noninvasive method to optimize therapy and risk stratification.
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