Division of Cardiology, Coronary Care Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Cardiovasc Ther. 2020 Jan 2;2020:4532596. doi: 10.1155/2020/4532596. eCollection 2020.
This prospective study aimed to evaluate the value of the cardiac cycle time-corrected electromechanical activation time (EMATc) measured at admission for predicting major cardiac adverse events (MACEs) in hospitalized patients with chronic heart failure (CHF).
CHF patients with a left ventricular ejection fraction (LVEF) lower than 50% ( = 145) were enrolled in this study. Documented clinical end-points (MACEs) included cardiogenic death, onset of acute HF as assessed with invasive and noninvasive mechanical ventilation, and cardiogenic shock. According to the different clinical end-points, patients were divided into two groups: a MACE group ( = 22) and a nonMACE group ( = 123). EMATc, LVEF, and circulating levels of B type natriuretic peptide (BNP) and Troponin I (TnI) were measured. Multivariate logistic regression analysis was used to examine the association between EMATc and MACEs. The parameters adjusted in the multivariable model included EMATc, BNP, and heart rate. The predictive value of EMATc was evaluated by receiver operating characteristic (ROC) curve analysis.
Elevated EMATc was an independent risk factor for MACEs ( 1.1443, 1.016-1.286, = 0.027). The area under the ROC curve for EMATc was 0.799 (95% 0.702-0.896, < 0.001). The optimal cutoff EMATc value was >13.8% with a sensitivity of 81.8% and a specificity of 65.9%.
We demonstrated that an elevated EMATc measured at admission is an independent risk factor for MACEs among hospitalized CHF patients. Acoustic cardiography measured at admission may provide a simple, noninvasive method for risk stratification of CHF patients. This trial is registered with ChiCTR1900021470.
本前瞻性研究旨在评估入院时校正心脏周期的机电激活时间（EMATc）对预测慢性心力衰竭（CHF）住院患者主要心脏不良事件（MACEs）的价值。
本研究纳入左心室射血分数（LVEF）<50%的 CHF 患者（n=145）。记录的临床终点（MACEs）包括心源性死亡、经有创和无创机械通气评估的急性 HF 发作以及心源性休克。根据不同的临床终点，患者被分为 MACE 组（n=22）和非 MACE 组（n=123）。测量 EMATc、LVEF 以及 B 型利钠肽（BNP）和肌钙蛋白 I（TnI）的循环水平。采用多变量逻辑回归分析来检查 EMATc 与 MACEs 之间的关联。多变量模型中调整的参数包括 EMATc、BNP 和心率。通过接收者操作特征（ROC）曲线分析评估 EMATc 的预测价值。
升高的 EMATc 是 MACEs 的独立危险因素（ 1.1443， 1.016-1.286， =0.027）。EMATc 的 ROC 曲线下面积为 0.799（95% 0.702-0.896， <0.001）。最佳截断值 EMATc 值>13.8%，灵敏度为 81.8%，特异性为 65.9%。
我们表明，入院时测量的升高的 EMATc 是住院 CHF 患者 MACEs 的独立危险因素。入院时的声学心动图可能为 CHF 患者的风险分层提供一种简单、无创的方法。本试验在中国临床试验注册中心注册，注册号为 ChiCTR1900021470。
