Clinical and Prognostic Significance of Positive Hepatojugular Reflux on Discharge in Acute Heart Failure: Insights from the ESCAPE Trial
| Autor: | Maya Guglin, Hesham R. Omar |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
Databases Factual Heart Valve Diseases lcsh:Medicine 030204 cardiovascular system & hematology Patient Admission 0302 clinical medicine Clinical endpoint Medicine 030212 general & internal medicine Hepatojugular reflux Clinical Trials as Topic Hazard ratio Central venous pressure General Medicine Middle Aged Prognosis Patient Discharge Hospitalization Treatment Outcome medicine.vein Echocardiography Area Under Curve Acute Disease Heart Function Tests Cardiology Female Research Article medicine.medical_specialty Article Subject Inferior vena cava General Biochemistry Genetics and Molecular Biology 03 medical and health sciences Internal medicine Humans Heart Atria Pulmonary Wedge Pressure Vascular Diseases Pulmonary wedge pressure Proportional Hazards Models Retrospective Studies Heart Failure General Immunology and Microbiology business.industry Proportional hazards model lcsh:R Hemodynamics medicine.disease Surgery Heart failure Jugular Veins business |
| Zdroj: | BioMed Research International, Vol 2017 (2017) BioMed Research International |
| ISSN: | 2314-6141 2314-6133 |
| Popis: | Background. There has been a decline in emphasis of the value of physical examination in heart failure (HF) with increased reliance on cardiac imaging. We aim to study the clinical and prognostic significance of positive hepatojugular reflux (HJR) on discharge in patients hospitalized with HF.Methods. Using the ESCAPE trial data, patients were compared according to the presence or absence of a positive HJR on discharge. The primary study endpoints were all-cause mortality and a composite endpoint of death, rehospitalization, and cardiac transplant during the first 6 months after discharge.Results. Among 392 patients (age: 56 years, 74% men), the HJR correlated well with clinical and objective hemodynamic markers of volume overload including right atrial pressure (RAP,P=0.002), pulmonary capillary wedge pressure (PCWP,P=0.006), and inferior vena cava size during inspiration (P=0.005) and expiration (P=0.003). The RAP had the highest AUC for predicting a positive HJR on admission (AUC: 0.655,P=0.004) and discharge (AUC: 0.672,P=0.001). Cox’s proportional hazards analysis revealed that a positive HJR on discharge is an independent predictor of 6-month mortality (estimated hazard ratio: 1.689; 95% CI: 1.032–2.764;P=0.037) after adjusting for age, baseline creatinine, baseline hematocrit, baseline NYHA class, chronic obstructive pulmonary disease, and the presence of tricuspid regurgitation.Conclusion. The HJR should be routinely checked in patients admitted with acute HF throughout hospitalization and especially on discharge as it serves as an important prognostic marker for postdischarge outcomes. |
| Databáze: | OpenAIRE |
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