Heart Failure and Cardiac Transplantation Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, Korea.
Eur Heart J. 2012 Feb;33(3):354-62. doi: 10.1093/eurheartj/ehr345. Epub 2011 Sep 5.
Although cerebral blood flow (CBF) is known to be low in patients with advanced systolic heart failure (HF), little is known of the prognostic significance of this observation. We investigated whether CBF might be associated with the development of adverse outcomes in systolic HF, and whether it might provide prognostic information in addition to that provided by exercise tests.
We performed a prospective observational study involving 224 systolic HF patients (left ventricular ejection fraction ≤35%). The study endpoint was the occurrence of cardiac death or urgent heart transplantation. Global CBF was measured using radionuclide angiography. Clinical, biochemical, echocardiographic, and exercise data were also obtained. During follow-up (median 36 months), 52 patients experienced death or urgent transplantation. Multivariable analysis showed that global CBF, the minute ventilation/carbon dioxide production (VE/VCO(2)) slope, New York Heart Association functional class ≥III, symptom duration ≥12 months, serum sodium, and serum creatinine were associated with the development of the endpoint. Patients with a CBF <35.4 mL/min/100 g were at increased risk of death or urgent transplantation (hazard ratio = 2.47; 95% confidence interval, 1.35-4.52). The addition of global CBF to a prognostic model including the VE/VCO(2) slope increased the C-index for the prediction of adverse outcomes with borderline significance.
Cerebral blood flow was associated with the development of long-term outcomes in systolic HF, and therefore may be useful in identifying patients suitable for heart transplantation. This finding is especially relevant for patients in whom exercise tests may not be performed sufficiently.
尽管已知在晚期收缩性心力衰竭（HF）患者中脑血流（CBF）较低，但对此观察结果的预后意义知之甚少。我们研究了 CBF 是否与收缩性 HF 不良结局的发生有关，以及它是否除了运动试验提供的预后信息之外还能提供预后信息。
我们进行了一项涉及 224 例收缩性 HF 患者（左心室射血分数≤35%）的前瞻性观察性研究。研究终点为心脏死亡或紧急心脏移植的发生。使用放射性核素血管造影术测量全脑 CBF。还获得了临床、生化、超声心动图和运动数据。在随访期间（中位数 36 个月），52 例患者发生死亡或紧急移植。多变量分析显示，全脑 CBF、分钟通气量/二氧化碳产量（VE/VCO2）斜率、纽约心脏协会功能分级≥III、症状持续时间≥12 个月、血清钠和血清肌酐与终点的发生相关。CBF<35.4mL/min/100g 的患者死亡或紧急移植的风险增加（危险比=2.47；95%置信区间，1.35-4.52）。将全脑 CBF 添加到包括 VE/VCO2 斜率的预后模型中，可使不良结局预测的 C 指数略有增加。
脑血流与收缩性 HF 的长期结局相关，因此可能有助于识别适合心脏移植的患者。对于那些可能无法充分进行运动试验的患者，这一发现尤为重要。
