门诊心衰恶化患者心脏充血多参数评估观察研究(EVOLUTION)

IF 16.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Gad Cotter, Beth Davison, Philip Janiak, Christopher Edwards, Maria Novosadova, Koji Takagi, Marie‐Laure Ozoux, Francesca Lawson, Hamlet Hayrapetyan, Hamayak Sisakian, Victor R. Ter‐Grigoryan, Katell Peoc'h, Alexandre Raynor, Paul Bruzeau, Alexis Nguyen, Alexandre Mebazaa
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Observational study for multiparametric assessment of cardiac congestion in outpatient worsening heart failure (EVOLUTION)
AimsWe sought to characterize the clinical course of patients following worsening heart failure (WHF) treated in an outpatient setting and to identify factors associated with a poor response to standard of care with loop diuretics.Methods and resultsBetween September 2022 and March 2023, 44 eligible patients (mean age 66.3 years, 84% male) with ejection fraction <50% and with WHF symptoms in the preceding week treated in an outpatient setting were enrolled. Patients were assessed weekly over 4 weeks following the WHF episode. At week 4, responses to fluid expansion and furosemide administration were assessed in 39 patients to unmask persistent subclinical congestion. Patients were on stable doses of guideline‐directed medical therapy (GDMT) with a mean daily furosemide dose of 47.4 mg. Patient‐reported and physician‐assessed symptoms and quality of life improved over the 4 weeks. At 1 h following 1 L Ringer solution infused over 2 h, the median (interquartile range) urine volume and urine sodium excreted over 3 h were 300 (200.0–500.0) ml and 39.6 (12.4–63.0) mEq, respectively. Receiver‐operating characteristic curves suggest that cystatin C >1.2 ng/ml, N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) >1500 pg/ml, and high‐sensitivity troponin T >20 pg/ml represent good predictors of non‐response to a fluid challenge (diuresis, natriuresis, and rales) following an outpatient WHF, with having all three markers associated with the worst response.ConclusionPatients with high levels of troponin, or NT‐proBNP, or cystatin C who develop WHF despite being treated with a loop diuretic, need novel therapies for WHF.
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来源期刊
European Journal of Heart Failure
European Journal of Heart Failure 医学-心血管系统
CiteScore
27.30
自引率
11.50%
发文量
365
审稿时长
1 months
期刊介绍: European Journal of Heart Failure is an international journal dedicated to advancing knowledge in the field of heart failure management. The journal publishes reviews and editorials aimed at improving understanding, prevention, investigation, and treatment of heart failure. It covers various disciplines such as molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, clinical sciences, social sciences, and population sciences. The journal welcomes submissions of manuscripts on basic, clinical, and population sciences, as well as original contributions on nursing, care of the elderly, primary care, health economics, and other related specialist fields. It is published monthly and has a readership that includes cardiologists, emergency room physicians, intensivists, internists, general physicians, cardiac nurses, diabetologists, epidemiologists, basic scientists focusing on cardiovascular research, and those working in rehabilitation. The journal is abstracted and indexed in various databases such as Academic Search, Embase, MEDLINE/PubMed, and Science Citation Index.
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