Chang Chun-Chin, Sung Shih-Hsien, Yu Wen-Chung, Cheng Hao-Min, Chen Chen-Huan
Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
ESC Heart Fail. 2015 Sep;2(3):184-193. doi: 10.1002/ehf2.12044. Epub 2015 Jul 14.
Both electromechanical activation time (EMAT) and pulsatile hemodynamics measured during the hospitalization course are useful in the prediction of cardiovascular outcomes in patients with acute heart failure syndrome (AHFS). We investigated whether night-time monitoring of EMAT with the ambulatory acoustic cardiography is superior to the measures of pulsatile hemodynamics for prediction of AHFS post-discharge outcomes.
A total of 97 patients (71.1 ± 15.4 years old, 81% male, and 73.8% systolic heart failure) hospitalized for AHFS were included. Before discharge, 24 h ambulatory acoustic cardiography and a comprehensive echocardiographic and pulsatile hemodynamic study were performed to assess the mean 24 h, daytime, and night-time EMAT, carotid systolic blood pressure (SBP) and pulse pressure (PP), amplitude of the reflected pressure wave from a decomposed carotid pressure wave (Pb), and carotid-femoral pulse wave velocity (cfPWV), in addition to measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. During a mean follow-up of 389 ± 281 days, 49 patients (50.5%) experienced events including re-hospitalization for heart failure, myocardial infarction, stroke, or death. Pulsatile hemodynamics, including carotid SBP and PP and Pb, but not cfPWV, and night-time EMAT, but not daytime EMAT, significantly predicted post-discharge events when age and NT-proBNP were accounted for (all P < 0.05). In a final model with adjustment for age and NT-proBNP, night-time EMAT, but not Pb, significantly predicted post-discharge events [hazard ratio per 1 SD and 95% confidence intervals: 1.33 (1.05-1.69), P < 0.05].
Pre-discharge night-time EMAT may be a better predictor for post-discharge adverse events than the measures of the pulsatile hemodynamics in patients with AHFS.
在急性心力衰竭综合征（AHFS）患者的住院过程中测量的机电激活时间（EMAT）和搏动性血流动力学指标均有助于预测心血管结局。我们研究了采用动态心音图进行夜间EMAT监测在预测AHFS出院后结局方面是否优于搏动性血流动力学指标。
纳入97例因AHFS住院的患者（年龄71.1±15.4岁，男性占81%，收缩性心力衰竭占73.8%）。出院前，进行了24小时动态心音图检查以及全面的超声心动图和搏动性血流动力学研究，以评估平均24小时、白天和夜间的EMAT、颈动脉收缩压（SBP）和脉压（PP）、分解后的颈动脉压力波的反射压力波幅度（Pb）以及颈动脉-股动脉脉搏波速度（cfPWV），此外还测量了N末端脑钠肽前体（NT-proBNP）水平。在平均389±281天的随访期间，49例患者（50.5%）发生了包括因心力衰竭再次住院、心肌梗死、中风或死亡在内的事件。在考虑年龄和NT-proBNP的情况下，搏动性血流动力学指标（包括颈动脉SBP、PP和Pb，但不包括cfPWV）以及夜间EMAT（但不包括白天EMAT）显著预测了出院后事件（所有P<0.05）。在调整年龄和NT-proBNP的最终模型中，夜间EMAT而非Pb显著预测了出院后事件[每1个标准差的风险比和95%置信区间：1.33（1.05-1.69），P<0.05]。
对于AHFS患者，出院前夜间EMAT可能比搏动性血流动力学指标更能预测出院后不良事件。
