Penn Cardiovascular Institute, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
J Am Coll Cardiol. 2013 Sep 24;62(13):1165-72. doi: 10.1016/j.jacc.2013.03.085. Epub 2013 Jun 13.
The objective of this study was to compare the physiological determinants of ejection fraction (EF)-ventricular size, contractile function, and ventricular-arterial (VA) interaction-and their associations with clinical outcomes in chronic heart failure (HF).
EF is a potent predictor of HF outcomes, but represents a complex summary measure that integrates several components including left ventricular size, contractile function, and VA coupling. The relative importance of each of these parameters in determining prognosis is unknown.
In 466 participants with chronic systolic HF, we derived quantitative echocardiographic measures of EF: cardiac size (end-diastolic volume [EDV]); contractile function (the end-systolic pressure volume relationship slope [Eessb] and intercept [V0]); and VA coupling (arterial elastance [Ea]/Eessb). We determined the association between these parameters and the following adverse outcomes: 1) the combined endpoint of death, cardiac transplantation, or ventricular assist device (VAD) placement; and 2) cardiac hospitalization.
Over a median follow-up of 3.4 years, there were 76 deaths, 52 transplantations, 14 VAD placements, and 684 cardiac hospitalizations. EF was independently associated with death, transplantation, and VAD placement (adjusted hazard ratio [HR]: 3.0; 95% confidence interval [CI]: 1.8 to 5.0 comparing third and first tertiles), as were EDV (HR: 2.6; 95% CI: 1.5 to 4.2); V0 (HR: 3.6; 95% CI: 2.1 to 6.1); and Ea/Eessb (HR: 2.1; 95% CI: 1.3 to 3.3). EDV, V0, and Ea/Eessb were also associated with risk of cardiac hospitalization. Eessb was not significantly associated with any adverse outcomes in adjusted analyses.
Left ventricular size, V0, and VA coupling are associated with prognosis in systolic HF, but end-systolic elastance (Eessb) is not. Assessment of VA coupling via Ea/Eessb is an additional noninvasively derived metric that can be used to gauge prognosis in human HF.
本研究旨在比较射血分数（EF）-心室大小、收缩功能和心室-动脉（VA）相互作用的生理决定因素，并评估其与慢性心力衰竭（HF）临床结局的关系。
EF 是 HF 预后的有力预测指标，但它是一个复杂的综合指标，整合了左心室大小、收缩功能和 VA 耦联等多个组成部分。这些参数中哪一个对预后的影响更大尚不清楚。
在 466 例慢性收缩性 HF 患者中，我们推导出 EF 的定量超声心动图测量值：心脏大小（舒张末期容积[EDV]）；收缩功能（收缩末期压力-容积关系斜率[Eessb]和截距[V0]）；以及 VA 耦联（动脉弹性[Ea]/Eessb）。我们确定了这些参数与以下不良结局之间的关系：1）死亡、心脏移植或心室辅助装置（VAD）植入的联合终点；2）心脏住院。
中位随访 3.4 年后，共有 76 例死亡、52 例移植、14 例 VAD 植入和 684 例心脏住院。EF 与死亡、移植和 VAD 植入独立相关（调整后的危险比[HR]：3.0；95%置信区间[CI]：1.8 至 5.0，第三和第一三分位数比较），EDV（HR：2.6；95% CI：1.5 至 4.2）；V0（HR：3.6；95% CI：2.1 至 6.1）；以及 Ea/Eessb（HR：2.1；95% CI：1.3 至 3.3）。EDV、V0 和 Ea/Eessb 也与心脏住院风险相关。Eessb 在调整后的分析中与任何不良结局均无显著相关性。
左心室大小、V0 和 VA 耦联与收缩性 HF 的预后相关，但收缩末期弹性（Eessb）则不然。通过 Ea/Eessb 评估 VA 耦联是一种可用于评估人类 HF 预后的额外无创衍生指标。
