Editorial
Importance of intra-abdominal pressure in patients with acute heart failure according to the left ventricular ejection fraction
Importancia de la presión intraabdominal en los pacientes con insuficiencia cardíaca aguda según la fracción de eyección ventricular izquierda
M. Montero-Pérez-Barquero
Departamento de Medicina Interna, IMIBIC/Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain
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Elola-Somoza, M.C. Bas-Villalobos, J. Pérez-Villacastín, C. Macaya-Miguel" "autores" => array:4 [ 0 => array:2 [ "nombre" => "F.J." "apellidos" => "Elola-Somoza" ] 1 => array:2 [ "nombre" => "M.C." "apellidos" => "Bas-Villalobos" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Pérez-Villacastín" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Macaya-Miguel" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256520303039" "doi" => "10.1016/j.rce.2020.11.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256520303039?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421000746?idApp=WRCEE" "url" => "/22548874/0000022100000007/v1_202107290541/S2254887421000746/v1_202107290541/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Importance of intra-abdominal pressure in patients with acute heart failure according to the left ventricular ejection fraction" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "404" "paginaFinal" => "405" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "M. Montero-Pérez-Barquero" "autores" => array:1 [ 0 => array:3 [ "nombre" => "M." "apellidos" => "Montero-Pérez-Barquero" "email" => array:2 [ 0 => "montero.manolo@gmail.com" 1 => "fm1mopem@uco.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Medicina Interna, IMIBIC/Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Importancia de la presión intraabdominal en los pacientes con insuficiencia cardíaca aguda según la fracción de eyección ventricular izquierda" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Despite recent advances, there continues to be a lack of knowledge on the pathophysiology of decompensated heart failure (HF). HF produces an increase in intravascular volume, intracavitary pressure, and central venous pressure, which translates into symptoms of congestion that we identify through jugular venous distention, edema, hepatomegaly, or ascites. Not only is the diagnosis of congestion important, it also has a notable prognostic value and achieving complete decongestion is an essential therapeutic objective. In many cases of HF, coexistence with renal dysfunction can complicate the course of treatment. In addition, treatments to alleviate congestion, such as diuretics, can worsen renal failure and increase mortality.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There is growing interest in the measurement of intra-abdominal pressure (IAP) in critical patients, which is associated with intra-abdominal organ dysfunction.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> The abdomen is delimited by four walls: the diaphragm, the pelvic floor, and the anterior and posterior abdominal muscles, such that the pressure generated by each of these elements in the interior of the abdominal chamber determines IAP. The IAP values in the healthy population range from 8 to 12 mmHg.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">An increase in IAP has been recognized as a significant cause of morbidity and mortality, especially in critical patients. Recognition of the high prevalence of IAP along with advances in the diagnosis and treatment of these patients has significantly improved its prognosis.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Elevated IAP in patients with decompensated heart failure has been associated with a worsening of renal function.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">This issue includes a report on the results of an interesting study which analyzed the relationship between IAP and systemic congestion in patients hospitalized due to decompensation of HF according to left ventricular ejection fraction (LVEF).</p><p id="par0025" class="elsevierStylePara elsevierViewall">This is a relevant study of scientific interest that included 56 patients hospitalized in internal medicine departments for symptoms of decompensated HF: 22 for HF with reduced LVEF (HFrEF) and 34 with HF with preserved LVEF (HFpEF). The evaluation of IAP was done through the placement of a bladder catheter that was connected to a manometer.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The degree of congestion was estimated through ultrasound, evaluating the degree of inferior vena cava collapse; through measuring impedance by measuring body water upon admission and at 72 h; and through determining the concentration of CA 125.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The results of this work demonstrate that IAP was higher among patients with HFrEF (17.2 mmHg vs. 13.3 mmHg) than those with HFpEF (<span class="elsevierStyleItalic">p</span> = .004). Patients with HFrEF presented with a higher degree of systemic congestion than patients with HFpEF (inferior wall collapse of 26% vs. 50%, respectively; <span class="elsevierStyleItalic">p</span> = .001).</p><p id="par0040" class="elsevierStylePara elsevierViewall">The authors indicate that these results suggest that though congestion is a fundamental problem in both types of HF, the mechanisms that produce it are different. In HFrEF, congestion may be more dependent on the expansion of blood volume whereas in HFpEF, it may be related to the deterioration of the diastolic properties of the heart and venous dilation (continent) as the predominant pathogenic factors.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Among the limitations of the study, which the authors themselves recognize, is the small sample size, which they explain as being due to difficulties in recruitment.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Despite the limitations mentioned, the work by Rubio-Gracia et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> sheds light on the pathophysiology of congestion in HF phenotypes and highlights the value in clinical practice of measuring IAP in patients with decompensated HF. We congratulate the authors for their contribution. Nevertheless, these results must be corroborated in future works.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-03-30" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Montero-Pérez-Barquero M. Importancia de la presión intraabdominal en los pacientes con insuficiencia cardíaca aguda según la fracción de eyección ventricular izquierda. Rev Clin Esp. 2021;221:404–405.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.D. Sackner-Bernstein" 1 => "H.A. Skopicki" 2 => "K.D. 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