Assi Milwidsky, Omar Saeed, Amrita Balgobind, Rachel Clark, Francesco Castagna, Shivank Madan, Yan Topilsky, Edwin C Ho, Azeem Latib, Ulrich P Jorde
{"title":"急性失代偿性心力衰竭中瓣膜性心力衰竭的独特组。","authors":"Assi Milwidsky, Omar Saeed, Amrita Balgobind, Rachel Clark, Francesco Castagna, Shivank Madan, Yan Topilsky, Edwin C Ho, Azeem Latib, Ulrich P Jorde","doi":"","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Functional mitral and tricuspid regurgitation (fMR and fTR, respectively) portend increased morbidity and mortality among heart failure (HF) patients.</p><p><strong>Objectives: </strong>To characterize acute decompensated valvular HF (VHF) as a novel HF category, defined by presence of either more than moderate fTR or more than moderate fMR with left ventricular ejection fraction (LVEF) ≤ 50%.</p><p><strong>Methods: </strong>Patients with VHF were prospectively enrolled over a 6-month period and compared to acute decompensated heart failure (ADHF) patients without significant fTR or fMR. We used a standardized diuretic protocol when indicated, and appropriate inpatient guideline-directed medical therapy was initiated.</p><p><strong>Results: </strong>Among 322 patients admitted with ADHF, 83 (26%) met VHF criteria with mean age 66 ± 13 years, 43 (52%) males, and median LVEF of 30% (20-55). Of 61 patients in whom the diuretic protocol was initiated, 59 (97%) had an adequate response (i.e., > 100 cc/hour for at least 6 hours). VHF patients had longer length of hospitalization (8 [5-13] vs. 5 [3-8] days, P < 0.001), and higher rates of 90-day heart replacement therapy (HRT) or death (hazard ratio 2.52, 95% confidence interval (1.13-5.64); P = 0.024).</p><p><strong>Conclusions: </strong>Over a quarter of ADHF patients can be newly categorized as VHF patients, distinguished by prolonged hospitalization and worse 90-day mortality / HRT rate. The initial response rate to a standardized diuretic protocol was high.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"27 9","pages":"561-566"},"PeriodicalIF":1.3000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Valvular Heart Failure as a Distinct Group in Acute Decompensated Heart Failure.\",\"authors\":\"Assi Milwidsky, Omar Saeed, Amrita Balgobind, Rachel Clark, Francesco Castagna, Shivank Madan, Yan Topilsky, Edwin C Ho, Azeem Latib, Ulrich P Jorde\",\"doi\":\"\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Functional mitral and tricuspid regurgitation (fMR and fTR, respectively) portend increased morbidity and mortality among heart failure (HF) patients.</p><p><strong>Objectives: </strong>To characterize acute decompensated valvular HF (VHF) as a novel HF category, defined by presence of either more than moderate fTR or more than moderate fMR with left ventricular ejection fraction (LVEF) ≤ 50%.</p><p><strong>Methods: </strong>Patients with VHF were prospectively enrolled over a 6-month period and compared to acute decompensated heart failure (ADHF) patients without significant fTR or fMR. We used a standardized diuretic protocol when indicated, and appropriate inpatient guideline-directed medical therapy was initiated.</p><p><strong>Results: </strong>Among 322 patients admitted with ADHF, 83 (26%) met VHF criteria with mean age 66 ± 13 years, 43 (52%) males, and median LVEF of 30% (20-55). Of 61 patients in whom the diuretic protocol was initiated, 59 (97%) had an adequate response (i.e., > 100 cc/hour for at least 6 hours). VHF patients had longer length of hospitalization (8 [5-13] vs. 5 [3-8] days, P < 0.001), and higher rates of 90-day heart replacement therapy (HRT) or death (hazard ratio 2.52, 95% confidence interval (1.13-5.64); P = 0.024).</p><p><strong>Conclusions: </strong>Over a quarter of ADHF patients can be newly categorized as VHF patients, distinguished by prolonged hospitalization and worse 90-day mortality / HRT rate. The initial response rate to a standardized diuretic protocol was high.</p>\",\"PeriodicalId\":50268,\"journal\":{\"name\":\"Israel Medical Association Journal\",\"volume\":\"27 9\",\"pages\":\"561-566\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Israel Medical Association Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Israel Medical Association Journal","FirstCategoryId":"3","ListUrlMain":"","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Valvular Heart Failure as a Distinct Group in Acute Decompensated Heart Failure.
Background: Functional mitral and tricuspid regurgitation (fMR and fTR, respectively) portend increased morbidity and mortality among heart failure (HF) patients.
Objectives: To characterize acute decompensated valvular HF (VHF) as a novel HF category, defined by presence of either more than moderate fTR or more than moderate fMR with left ventricular ejection fraction (LVEF) ≤ 50%.
Methods: Patients with VHF were prospectively enrolled over a 6-month period and compared to acute decompensated heart failure (ADHF) patients without significant fTR or fMR. We used a standardized diuretic protocol when indicated, and appropriate inpatient guideline-directed medical therapy was initiated.
Results: Among 322 patients admitted with ADHF, 83 (26%) met VHF criteria with mean age 66 ± 13 years, 43 (52%) males, and median LVEF of 30% (20-55). Of 61 patients in whom the diuretic protocol was initiated, 59 (97%) had an adequate response (i.e., > 100 cc/hour for at least 6 hours). VHF patients had longer length of hospitalization (8 [5-13] vs. 5 [3-8] days, P < 0.001), and higher rates of 90-day heart replacement therapy (HRT) or death (hazard ratio 2.52, 95% confidence interval (1.13-5.64); P = 0.024).
Conclusions: Over a quarter of ADHF patients can be newly categorized as VHF patients, distinguished by prolonged hospitalization and worse 90-day mortality / HRT rate. The initial response rate to a standardized diuretic protocol was high.
期刊介绍:
The Israel Medical Association Journal (IMAJ), representing medical sciences and medicine in Israel, is published in English by the Israel Medical Association.
The Israel Medical Association Journal (IMAJ) was initiated in 1999.