Heart-Lung-Physiology Clinic, Örebro University Hospital, Örebro, Sweden.
Cardiology, Military Hospital State Health Centre, Budapest, Hungary.
PLoS One. 2018 Dec 12;13(12):e0207269. doi: 10.1371/journal.pone.0207269. eCollection 2018.
Left ventricular ejection fraction (LVEF) is the most frequently used parameter in the assessment of heart failure (HF). Cardiac index (CI) is considered a potential alternative to LVEF despite limited evidence. We aimed to assess and compare the predictive accuracy of LVEF and echocardiographically-assessed CI in HF patients.
A single-centre, retrospective cohort study was conducted in patients hospitalized for acute HF from 2010-2016. Cox proportional hazard models including either LVEF or CI were created to predict all cause death, cardiovascular (CV) death, or first HF-readmission. Of 334 patients included in the analysis, 58.7% exhibited HF with reduced LVEF (HFrEF). Left ventricular ejection fraction did not show correlation with any endpoint, while CI was predictive of HF-readmission in the entire cohort. Both the LVEF-based and CI-based models demonstrated moderate discriminative accuracy when predicting all-cause death, CV death, or HF-readmission. Left ventricular ejection fraction proved to be an independent predictor of CV mortality in HFrEF-patients, while CI was predictive of HF-readmission in the non-HFrEF group.
Left ventricular ejection fraction seemed to be associated more closely with disease severity in HFrEF, and CI in the non-HFrEF group, in this real-life cohort of elderly HF patients. The LVEF-based and CI-based predictive models have clinically similar predictive accuracy for mortality and HF-readmission, thus CI may be a potential alternative to LVEF in the assessment of left ventricular function. Cardiac index may be an important new tool in the assessment of HF patients with midrange or preserved LVEF.
左心室射血分数（LVEF）是心力衰竭（HF）评估中最常用的参数。尽管证据有限，但心输出量（CI）被认为是 LVEF 的潜在替代指标。我们旨在评估和比较 LVEF 和超声心动图评估的 CI 在 HF 患者中的预测准确性。
这是一项单中心、回顾性队列研究，纳入了 2010 年至 2016 年因急性 HF 住院的患者。创建了包含 LVEF 或 CI 的 Cox 比例风险模型，以预测全因死亡、心血管（CV）死亡或首次 HF 再入院。在纳入分析的 334 例患者中，58.7%的患者表现为射血分数降低的 HF（HFrEF）。LVEF 与任何终点均无相关性，而 CI 可预测整个队列的 HF 再入院。基于 LVEF 和 CI 的模型在预测全因死亡、CV 死亡或 HF 再入院时均具有中等的判别准确性。LVEF 被证明是 HFrEF 患者 CV 死亡率的独立预测因子，而 CI 可预测非 HFrEF 组的 HF 再入院。
在这个老年 HF 患者的真实队列中，LVEF 似乎与 HFrEF 患者的疾病严重程度更密切相关，而 CI 与非 HFrEF 组相关。基于 LVEF 和 CI 的预测模型对死亡率和 HF 再入院的预测准确性具有临床相似性，因此 CI 可能是 LVEF 在评估左心室功能方面的潜在替代指标。CI 可能是评估中、高 LVEF HF 患者的重要新工具。
