Assessment of Dyspnea in Acute Decompensated Heart Failure Insights from ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) on the Contributions of Peak Expiratory Flow

作者：Ezekowitz Justin A^*; Hernandez Adrian F; O' Connor Christopher M; Starling Randall C; Proulx Guy; Weiss Mason H; Bakal Jeffrey A; Califf Robert M; McMurray John J V; Armstrong Paul W

来源：Journal of the American College of Cardiology, 2012, 59(16): 1441-1448.

DOI：10.1016/j.jacc.2011.11.061

• heart failure
• respiration
• trials

Objectives %26lt;br%26gt;This study hypothesized that peak expiratory flow rate (PEFR) would increase with acute heart failure (AHF) treatment over the first 24 h, related to a Dyspnea Index (DI) change and treatment effect. %26lt;br%26gt;Background %26lt;br%26gt;Dyspnea is a key symptom and clinical trial endpoint in AHF, yet objective assessment is lacking. %26lt;br%26gt;Methods %26lt;br%26gt;In a clinical trial substudy, 421 patients (37 sites) underwent PEFR testing at baseline, 1, 6, and 24 h after randomization to nesiritide or placebo. DI (by Likert scale) was collected at hours 6 and 24. %26lt;br%26gt;Results %26lt;br%26gt;Patients were median age 70 years, and 34% were female; no significant differences between nesiritide or placebo patients existed. Median baseline PEFR was 225 l/min (interquartile range [IQR]: 160 to 300 l/min) and increased to 230 l/min (2.2% increase; IQR: 170 to 315 l/min) by hour 1, 250 l/min (11.1% increase; IQR: 180 to 340 l/min) by hour 6, and 273 l/min (21.3% increase; IQR: 200 to 360 l/min) by 24 h (all p %26lt; 0.001). The 24-h PEFR change related to moderate or marked dyspnea improvement by DI (adjusted odds ratio: 1.04 for each 10 l/min improvement [95% confidence interval (CI): 1.07 to 1.10]; p %26lt; 0.01). A model incorporating time and treatment over 24 h showed greater PEFR improvement after nesiritide compared with placebo (p = 0.048). %26lt;br%26gt;Conclusions %26lt;br%26gt;PEFR increases over the first 24 h in AHF and could serve as an AHF endpoint. Nesiritide had a greater effect than placebo on PEFR, and this predicted patients with moderate/marked improvement in dyspnea, thereby providing an objective metric for assessing AHF. (Acu

• 出版日期2012-4-17