Kitada Shuichi, Kawada Yu, Osaga Satoshi, Kato Marina, Kikuchi Shohei, Wakami Kazuaki, Seo Yoshihiro, Ohte Nobuyuki
Department of Cardiology, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, Japan.
Department of Medical Innovation, Nagoya City University, Nagoya, Japan.
Heart Vessels. 2020 Dec;35(12):1689-1698. doi: 10.1007/s00380-020-01641-w. Epub 2020 Jun 5.
Heart failure (HF) with mid-range left ventricular ejection fraction (LVEF) (HFmrEF) is considered a new category of HF and LVEF < 50%, which is the upper threshold of LVEF for HFmrEF, is thought to represent a mild decrease in LV contractile performance. We aimed to consider an LVEF threshold value to be taken as a surrogate for impairment of LV contractile performance, resulting in new-onset HF. We enrolled 398 patients with LVEF ≥ 40% that underwent cardiac catheterization. Using the LV pressure recording with a catheter-tipped micromanometer, we calculated the inertia force of late systolic aortic flow (IFLSAF), which was sensitive to the slight impairment in LV contractile performance. We evaluated the utility of the IFLSAF for predicting future cardiovascular death or hospitalization for HF. We performed a receiver operating characteristic (ROC) curve analysis to determine the best LVEF threshold value for distinguishing whether the LV maintained the IFLSAF. A multivariate Cox proportional-hazards model revealed that the loss of IFLSAF was significantly associated with the future adverse events (HR: 7.798, 95%CI 2.174-27.969, p = 0.002). According to the ROC curve analysis, an LVEF ≥ 58% indicated that the LV could maintain the IFLSAF. We concluded that the loss of IFLSAF, which could reflect even slight impairment in LV contractile performance, was a reliable indicator for new-onset HF in patients with LVEF ≥ 40%. LVEF ≥ 58% could be taken as a surrogate for the IFLSAF maintenance; this threshold could be useful for risk stratification of new-onset HF in patients with preserved LVEF.
射血分数保留的心力衰竭（HF）伴射血分数中间范围（HFmrEF）被视为一种新的HF类型，且HFmrEF的左心室射血分数（LVEF）<50%（这是HFmrEF的LVEF上限）被认为代表左心室收缩功能轻度下降。我们旨在确定一个LVEF阈值，将其作为左心室收缩功能受损导致新发HF的替代指标。我们纳入了398例LVEF≥40%且接受了心导管检查的患者。使用带有导管尖端微测压计的左心室压力记录，我们计算了收缩晚期主动脉血流的惯性力（IFLSAF），其对左心室收缩功能的轻微受损敏感。我们评估了IFLSAF预测未来心血管死亡或因HF住院的效用。我们进行了受试者工作特征（ROC）曲线分析，以确定区分左心室是否维持IFLSAF的最佳LVEF阈值。多变量Cox比例风险模型显示，IFLSAF的丧失与未来不良事件显著相关（风险比：7.798，95%置信区间2.174 - 27.969，p = 0.002）。根据ROC曲线分析，LVEF≥58%表明左心室能够维持IFLSAF。我们得出结论，IFLSAF的丧失，即使能反映左心室收缩功能的轻微受损，也是LVEF≥40%患者新发HF的可靠指标。LVEF≥58%可作为IFLSAF维持的替代指标；该阈值可能有助于对LVEF保留的新发HF患者进行风险分层。
