循環器ジャーナル65巻1号

2017年01月発行

特集 Clinical Scenarioによる急性心不全治療 Ⅳ．Clinical Scenario 2：体液過剰を伴う急性心不全

Congestionとは何か？

著者： 猪又孝元¹

所属機関： ¹北里大学北里研究所病院循環器内科

ページ範囲：P.52 - P.58

Point
・多くの心不全患者での主徴候は，うっ血（congestion）である．
・うっ血をとりきることで，心不全予後は改善する．
・繰り返し入院の臨床像として，高齢者，腎機能障害，HFpEFでのうっ血増悪が多い．

参考文献

1) Cleland JG, Swedberg K, Follath F, et al:The EuroHeart Failure survey programme--a survey on the quality of care among patients with heart failure in Europe. Part 1:patient characteristics and diagnosis. Eur Heart J 24:442-463, 2003

2) Aronson D, Abassi Z, Allon E, et al:Fluid loss, venous congestion, and worsening renal function in acute decompensated heart failure. Eur J Heart Fail 15:637-643, 2013

3) Tang WH, Mullens W:Cardiorenal syndrome in decompensated heart failure. Heart 96:255-260, 2010

4) Greene SJ, Gheorghiade M, Vaduganathan M, et al:Haemoconcentration, renal function, and post-discharge outcomes among patients hospitalized for heart failure with reduced ejection fraction:insights from the EVEREST trial. Eur J Heart Fail 15:1401-1411, 2013

5) Testani JM, Brisco MA, Chen J, et al:Timing of hemoconcentration during treatment of acute decompensated heart failure and subsequent survival:importance of sustained decongestion. J Am Coll Cardiol 62:516-524, 2013

6) Ambrosy AP, Pang PS, Khan S, et al:Clinical course and predictive value of congestion during hospitalization in patients admitted for worsening signs and symptoms of heart failure with reduced ejection fraction:findings from the EVEREST trial. Eur Heart J 34:835-843, 2013

7) Logeart D, Thabut G, Jourdain P, et al:Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure. Am Coll Cardiol 43:635-641, 2004

8) Yu CM, Wang L, Chau E, et al:Intrathoracic impedance monitoring in patients with heart failure:correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation 112:84184-84188, 2005

9) Drazner MH, Brown RN, Kaiser PA, et al:Relationship of right- and left-sided filling pressures in patients with advanced heart failure:a 14-year multi-institutional analysis. J Heart Lung Transplant 31:67-72, 2012

10) Meyer P, Filippatos GS, Ahmed MI, et al:Effects of right ventricular ejection fraction on outcomes in chronic systolic heart failure. Circulation 121:252-258, 2010

11) Bhella PS, Pacini, EL, Prasad A, et al:Echocardiographic indices do not reliably track changes in left-sided filling pressure in healthy subjects or patients with heart failure with preserved ejection fraction. Circ Cardiovasc Imaging 4:482-489, 2011

12) Kalantari K, Chang JN, Ronco C, et al:Assessment of intravascular volume status and volume responsiveness in critically ill patients. Kidney Int 83:1017-1028, 2013

13) O'Connor CM, Miller AB, Blair JE, et al:Causes of death and rehospitalization in patients hospitalized with worsening heart failure and reduced left ventricular ejection fraction:results from Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan（EVEREST）program. Am Heart J 159:841-849, 2010

14) Fonarow GC, Stough WG, Abraham WT, et al:Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure:a report from the OPTIMIZE-HF Registry. J Am Coll Cardiol 50:768-777, 2007

15) Bueno H, Ross JS, Wang Y, et al:Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993-2006. JAMA 303:2141-2147, 2010

16) Sato N, Kajimoto K, Keida T, et al:Clinical features and outcome in hospitalized heart failure in Japan（from the ATTEND Registry）. Circ J 77:944-951, 2013

17) Gheorghiade M, Pang PS. Acute heart failure syndromes. J Am Coll Cardiol 53:557-573, 2009

18) Mullens W, Abrahams Z, Francis GS, et al:Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol 53:589-596, 2009

19) Sambandam KK:Am J Med Sci 2013 Apr 12.［Epub ahead of print］.

20) Kearney MT, Fox KA, Lee AJ, et al:Predicting death due to progressive heart failure in patients with mild-to-moderate chronic heart failure. J Am Coll Cardiol 40:1801-1808, 2002