Kim In-Cheol, Hong Geu-Ru, Pedrizzetti Gianni, Shim Chi Young, Kang Seok-Min, Chung Namsik
Division of Cardiology, Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea; Division of Cardiology, Keimyung University, Dongsan Medical Center, Daegu, Korea.
Division of Cardiology, Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea.
Ultrasound Med Biol. 2018 Sep;44(9):1951-1959. doi: 10.1016/j.ultrasmedbio.2018.05.015. Epub 2018 Jul 3.
The goal of the study described here was to evaluate whether left ventricular vortex flow parameters, as assessed by contrast echocardiography, enhance prediction of major adverse cardiac events (MACE) in patients with chronic heart failure and systolic dysfunction. A total of 75 patients with contrast echocardiography and systolic dysfunction (ejection fraction ≤45%) were prospectively enrolled and underwent vortex flow analysis with particle image velocimetry using contrast echocardiography. Vortex flow parameters, including kinetic energy fluctuation (KEF), were evaluated. Patients were followed up for a primary endpoint of MACE that comprised hospital admission for cardiovascular causes and cardiac deaths. Across a median 277-d follow-up, 29 patients (38.7%) experienced MACE. Among these, the incidence of diabetes and the E/e' ratio were significantly higher in patients with MACE than in those without, whereas the hemoglobin level and ejection fraction were significantly lower. KEF was significantly lower in patients with MACE. In the multivariate analysis, higher KEF was associated with a lower risk of MACE (hazard ratio = 0.18, 95% confidence interval: 0.04-0.97, p = 0.046). The addition of KEF to a model with conventional parameters (e.g., age, diabetes, ejection fraction and the E/e' ratio) significantly improved the model's discrimination. Elevations in the quantitative left ventricular vortex flow parameter, KEF, as determined by contrast echocardiography, are associated with a lower risk of MACE and improved functional status among patients with chronic heart failure.
本文所述研究的目的是评估经对比超声心动图评估的左心室涡流参数是否能增强对慢性心力衰竭和收缩功能障碍患者主要不良心脏事件（MACE）的预测。共有75例有对比超声心动图检查结果且存在收缩功能障碍（射血分数≤45%）的患者被前瞻性纳入研究，并使用对比超声心动图通过粒子图像测速技术进行涡流分析。评估了包括动能波动（KEF）在内的涡流参数。对患者进行随访，以MACE作为主要终点，MACE包括因心血管原因住院和心脏死亡。在中位277天的随访期内，29例患者（38.7%）发生了MACE。其中，发生MACE的患者中糖尿病发病率和E/e'比值显著高于未发生MACE的患者，而血红蛋白水平和射血分数则显著更低。发生MACE的患者KEF显著更低。在多变量分析中，较高的KEF与较低的MACE风险相关（风险比=0.18，95%置信区间：0.04-0.97，p=0.046）。将KEF添加到包含传统参数（如年龄、糖尿病、射血分数和E/e'比值）的模型中，显著改善了模型的辨别力。经对比超声心动图测定的左心室定量涡流参数KEF升高，与慢性心力衰竭患者较低的MACE风险和改善的功能状态相关。
