Cetin Mehmet S, Ozcan Cetin Elif H, Canpolat Ugur, Sasmaz Hatice, Temizhan Ahmet, Aydogdu Sinan
Cardiology Department, Turkey Yuksek Ihtisas Training and Research Hospital, Kizilay Street, Ankara, 06100, Turkey.
Cardiology Department, Hacettepe University School of Medicine, Ankara, Turkey.
Int J Cardiovasc Imaging. 2018 Feb;34(2):211-222. doi: 10.1007/s10554-017-1226-8. Epub 2017 Aug 14.
In heart failure with reduced ejection fraction (HFrEF) patients, myocardial blood flow (MBF), myocardial energy expenditure (MEE), myocardial efficiency has been poorly evaluated because of the necessity of invasive procedures in the determination of these parameters. Transthoracic echocardiography (TTE) can provide reliable data for MEE, MBF (via coronary sinus (CS) flows). Also, myocardial efficiency can be evaluated by the MEE to MBF ratio. We aim to assess MBF, MEE and energy efficiency and the prognostic value of these parameters in HFrEF. In this prospective study, a total of 80 patients with HFrEF due to either ischemic or non-ischemic etiology and 20 healthy control subjects were included. Median follow-up duration was 901 (27-1004) days. MBF was calculated via coronary sinus blood flow. MEE was measured from circumferential end-systolic stress, stroke volume and left ventricular ejection time. MEE to MBF ratio was determined as MEf. Primary composite end-point (CEP) was cardiovascular mortality, heart transplantation or mechanical circulatory support. MEE and MEf were lower and MBF per minute was higher in HF group compared to control subjects whereas MBF per 100 g left ventricular mass was not different. MEE and MEf have significantly negative correlation with troponin I, BNP, uric acid and positive correlation with epicardial fat thickness. In Cox regression analysis, per one calorie decrease of MEE was associated 4.3 times increased risk [HR 4.396 (95% CI 1.230-15.716)] and per one percent decrease of MEf was associated 3.3 times increased risk of CEP [HR 3.343 (95% CI 1.025-10.905)]. Our study demonstrated that while MEE and MEf diminished in HFrEF, MBF preserved with the symptomatic progression of HF. MEE and MEf were found to be associated with important prognostic markers and independent predictors of CEP in HFrEF. Evaluation of MEE, MBF and MEf with echocardiography may provide an additional data regarding prognostic assessment of HFrEF population.
在射血分数降低的心力衰竭（HFrEF）患者中，由于测定这些参数需要进行侵入性操作，心肌血流量（MBF）、心肌能量消耗（MEE）、心肌效率一直未得到充分评估。经胸超声心动图（TTE）可为MEE、MBF（通过冠状窦（CS）血流）提供可靠数据。此外，心肌效率可通过MEE与MBF的比值来评估。我们旨在评估HFrEF患者的MBF、MEE和能量效率以及这些参数的预后价值。在这项前瞻性研究中，共纳入了80例因缺血性或非缺血性病因导致的HFrEF患者以及20名健康对照者。中位随访时间为901（27 - 1004）天。MBF通过冠状窦血流计算得出。MEE通过圆周收缩末期应力、每搏输出量和左心室射血时间测量得出。MEE与MBF的比值被确定为MEf。主要复合终点（CEP）为心血管死亡、心脏移植或机械循环支持。与对照组相比，HF组的MEE和MEf较低，每分钟MBF较高，而每100 g左心室质量的MBF无差异。MEE和MEf与肌钙蛋白I、脑钠肽、尿酸呈显著负相关，与心外膜脂肪厚度呈正相关。在Cox回归分析中，MEE每降低一卡路里，CEP风险增加4.3倍[风险比（HR）4.396（95%置信区间1.230 - 15.716）]，MEf每降低1%，CEP风险增加3.3倍[HR 3.343（95%置信区间1.025 - 10.905）]。我们的研究表明，在HFrEF中，虽然MEE和MEf降低，但MBF随着HF症状的进展而保持。发现MEE和MEf与重要的预后标志物相关，并且是HFrEF中CEP的独立预测因素。用超声心动图评估MEE、MBF和MEf可能为HFrEF人群的预后评估提供额外的数据。
