Background:

Congestion predominates in exacerbations of heart failure with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF), but evidence suggests that excess volume may be distributed differently in these 2 subgroups.

Methods and Results:

In this retrospective study, diuretic efficiency (DE, or net urine output per 40-mg of intravenous furosemide equivalent) during the first 72 hours was compared between patients hospitalized with HFrEF (n = 121) versus HFpEF (n = 120). Multivariate analysis was used to compare the 2 groups based on expected baseline differences (e.g., demographics, heart failure etiology, concomitant therapy). During the first 72 hours, mean daily diuretic doses were higher in patients with HFpEF versus HFrEF (172.0 vs. 159.9 mg, respectively, p = 0.026) but urine output was not significantly different (2603.3 mL vs. 2667.5 mL, respectively, adjusted p = 0.100). Similarly, mean cumulative DE did not differ (−673.5 vs. −637.8 mL/40-mg in the HFrEF and HFpEF groups, respectively, adjusted p = 0.884). An exploratory analysis of propensity-matched cohorts yielded similar findings. Correlations between the components of DE varied considerably and only became weak to moderately correlated toward the end of the observation period.

Conclusions:

Although cumulative DE did not differ between patients with HFrEF and HFpEF, variable correlations in the components of DE suggest there may be differences in diuretic response that warrant future analysis.

中文翻译：

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比较心力衰竭住院患者与射血分数降低与保留射血分数的利尿模式：回顾性分析。

背景：

充血在射血分数降低 (HFrEF) 或射血分数保留 (HFpEF) 的心力衰竭加重中占主导地位，但有证据表明，在这两个亚组中，过多的容量可能分布不同。

方法和结果：

在这项回顾性研究中，比较了 HFrEF 住院患者（n = 121）与 HFpEF 住院患者（n = 120）在最初 72 小时内的利尿效率（DE，或每 40 mg 静脉速尿当量的净尿量）。多变量分析用于根据预期基线差异（例如，人口统计学、心力衰竭病因、伴随治疗）比较两组。在最初的 72 小时内，HFpEF 患者的平均每日利尿剂剂量高于 HFrEF（分别为 172.0 和 159.9 mg，p = 0.026），但尿量没有显着差异（分别为 2603.3 mL 和 2667.5 mL，调整后的 p = 0.100）。同样，平均累积 DE 没有差异（HFrEF 和 HFpEF 组分别为 -673.5 对 -637.8 mL/40-mg，调整后的 p = 0.884）。对倾向匹配队列的探索性分析得出了类似的发现。DE 各组成部分之间的相关性差异很大，并且在观察期结束时仅变得弱到中度相关。

结论：

尽管 HFrEF 和 HFpEF 患者的累积 DE 没有差异，但 DE 成分的可变相关性表明利尿剂反应可能存在差异，值得未来分析。