Kanda Takashi, Uematsu Masaaki, Fujita Masashi, Iida Osamu, Masuda Masaharu, Okamoto Shin, Ishihara Takayuki, Nanto Kiyonori, Tsujimura Takuya, Matsuda Yasuhiro, Okuno Shota, Mano Toshiaki
Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
Institute for Clinical Research, Osaka National Hospital, Osaka, Japan.
Heart Vessels. 2018 Dec;33(12):1490-1495. doi: 10.1007/s00380-018-1211-8. Epub 2018 Jun 22.
Predictors of outcomes in patients with heart failure with preserved left-ventricular ejection fraction (HFpEF) remain unclear. The ratio of early diastolic transmitral flow velocity to early diastolic myocardial velocity (E/e') has been proposed, but the predictive accuracy remains unsatisfactory. We hypothesized that E/e' normalized by the stroke volume (SV), E/e'/SV, could be a good predictor of outcome in HFpEF patients by reflecting the terminal slope of the end-diastolic pressure-volume relation, i.e., stiffness of the left ventricle. This pilot study was conducted to propose a novel echocardiographic index for predicting the outcomes of patients with HFpEF. Echocardiography including E/e'/SV measurement was performed in consecutive 80 HFpEF patients at discharge in index hospitalization due to HF. The end points included the readmission for heart failure and cardiovascular death at 1 year after discharge. 19 patients (24%) met the end points. Receiver-operating characteristic analysis showed that E/e''/SV was a strong predictive factor (AUC = 0.78) compared to E/e' (AUC = 0.74). Kaplan-Meier analysis showed that patients with E/e'/SV > 0.40 had a poorer prognosis than those with E/e'/SV < 0.40 (p < 0.01). By Cox regression multi-variate analysis, a high E/e'/SV was an independent predictor of event-free survival [adjusted hazard ratio (95% CI) 14.26 (3.18, 63.93) (p = 0.01)]. E/e'/SV has potential to predict clinical outcomes in patients with HFpEF.
射血分数保留的心力衰竭（HFpEF）患者预后的预测因素仍不明确。有人提出舒张早期二尖瓣血流速度与舒张早期心肌速度之比（E/e'），但其预测准确性仍不尽人意。我们假设通过每搏输出量（SV）进行标准化的E/e'，即E/e'/SV，通过反映舒张末期压力-容积关系的终末斜率，也就是左心室的僵硬度，可能是HFpEF患者预后的良好预测指标。本前瞻性研究旨在提出一种用于预测HFpEF患者预后的新型超声心动图指标。对因心力衰竭住院的80例HFpEF患者出院时进行了包括E/e'/SV测量在内的超声心动图检查。终点包括出院后1年因心力衰竭再次入院和心血管死亡。19例患者（24%）达到终点。受试者工作特征分析显示，与E/e'（AUC = 0.74）相比，E/e''/SV是一个更强的预测因素（AUC = 0.78）。Kaplan-Meier分析显示，E/e'/SV > 0.40的患者预后比E/e'/SV < 0.40的患者差（p < 0.01）。通过Cox回归多变量分析，高E/e'/SV是无事件生存的独立预测因素[调整后风险比（95%CI）14.26（3.18，63.93）（p = 0.01）]。E/e'/SV有潜力预测HFpEF患者的临床预后。
