Gilewski Wojciech, Pietrzak Jarosław, Banach Joanna, Bujak Robert, Błażejewski Jan, Karasek Danuta, Wołowiec Łukasz, Sinkiewicz Władysław
2nd Chair of Cardiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.
Heart Vessels. 2018 Feb;33(2):180-190. doi: 10.1007/s00380-017-1044-x. Epub 2017 Sep 22.
The aim of the study was to verify prognostic value of selected echocardiographic (UKG), impedance cardiography (ICG), and right heart catheterization (RHC) parameters in systolic heart failure (HF). UKG, ICG, and RHC were performed in 46 patients with chronic HF with ejection fraction <35%. During a 1-year follow-up, composite endpoint (death or hospitalization due to HF exacerbation) was achieved by 23 (50.0%) patients. Analysis of receiver operating characteristic (ROC) curves identified UKG parameters: inferior vena cava diameter on inspiration (IVCinsp) >13 mm [area under curve (AUC), 0.791], right atrial (RA) >5.2 cm (AUC 0.710) and ventricular dimension (RVD) >3.5 cm (AUC 0.717), tricuspid annular plane systolic excursion (TAPSE) <17 mm (AUC 0.682), and its velocity (S'RV) <6.07 cm/s (AUC 0.716) as unfavorable prognostic factors. RHC parameters: low values of cardiac index (CI < 2.1 L/min; AUC 0.846) and high pulmonary capillary wedge pressure (PCWP > 24 mmHg; AUC 0.773) turned out to be the most accurate single predictors of worse outcome. Prognostic value of non-invasive parameters was improved due to the use of their composite measures: IVC% × TAPSE (<430%/mm; AUC 0.826), RVSP/TAPSE (>2.4 mmHg/mm; AUC 0.800), IVC% × SBP (>2097% mmHg; AUC 0.826), and RA × IVCinsp/S'RV (>11.8 cm s; AUC 0.839). In conclusion, composite measures based on non-invasive parameters, such as IVC%/TAPSE, RVSP/TAPSE and RA × IVCinsp/S'RV, may provide equally accurate prognosis as the invasive examination. PCWP and CI determined during RHC were the best individual predictors of the composite endpoint. In addition, echocardiographic parameters: RVD, RA, IVC, TAPSE, and S'RV are accurate predictors of the unfavorable outcome.
本研究的目的是验证选定的超声心动图（UKG）、阻抗心动图（ICG）和右心导管检查（RHC）参数在收缩性心力衰竭（HF）中的预后价值。对46例射血分数<35%的慢性HF患者进行了UKG、ICG和RHC检查。在1年的随访期间，23例（50.0%）患者达到了复合终点（因HF加重导致的死亡或住院）。对受试者工作特征（ROC）曲线的分析确定了UKG参数：吸气时下腔静脉直径（IVCinsp）>13 mm[曲线下面积（AUC），0.791]、右心房（RA）>5.2 cm（AUC 0.710）和心室尺寸（RVD）>3.5 cm（AUC 0.717）、三尖瓣环平面收缩期位移（TAPSE）<17 mm（AUC 0.682）及其速度（S'RV）<6.07 cm/s（AUC 0.716）为不良预后因素。RHC参数：低心脏指数（CI<2.1 L/min；AUC 0.846）和高肺毛细血管楔压（PCWP>24 mmHg；AUC 0.773）被证明是预后较差的最准确单一预测指标。由于使用了非侵入性参数的综合测量方法，其预后价值得到了提高：IVC%×TAPSE（<430%/mm；AUC 0.826）、RVSP/TAPSE（>2.4 mmHg/mm；AUC 0.800）、IVC%×SBP（>2097% mmHg；AUC 0.826）和RA×IVCinsp/S'RV（>11.8 cm s；AUC 0.839）。总之，基于非侵入性参数（如IVC%/TAPSE、RVSP/TAPSE和RA×IVCinsp/S'RV）的综合测量方法可能提供与侵入性检查同样准确的预后。RHC期间测定的PCWP和CI是复合终点的最佳个体预测指标。此外，超声心动图参数：RVD、RA、IVC、TAPSE和S'RV是不良结局的准确预测指标。
