Cardiology Unit and LTTA Centre, University of Ferrara, Ferrara, Italy.
Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.
Int J Cardiovasc Imaging. 2021 Jan;37(1):59-68. doi: 10.1007/s10554-020-01946-x. Epub 2020 Jul 30.
Assessment of left ventricular (LV) output in hospitalized patients with heart failure (HF) is important to determine prognosis. Although echocardiographic LV ejection fraction (EF) is generally used to this purpose, its prognostic value is limited. In this investigation LV-EF was compared with other echocardiographic per-beat measures of LV output, including non-indexed stroke volume (SV), SV index (SVI), stroke distance (SD), ejection time (ET), and flow rate (FR), to determine the best predictor of all-cause mortality in patients hospitalized with HF. A final cohort of 350 consecutive patients hospitalized with HF who underwent echocardiography during hospitalization was studied. At a median follow-up of 2.7 years, 163 patients died. Non-survivors at follow-up had lower SD, SVI and SV, but not ET, FR and LV-EF than survivors. At multivariate analysis, only age, systolic blood pressure, chronic kidney disease, chronic obstructive pulmonary disease, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and SVI remained significantly associated with outcome [HR for SVI 1.13 (1.04-1.22), P = 0.003]. In particular, for each 5 ml/m decrease in SVI, a 13% increase in risk of mortality for any cause was observed. SVI is a powerful prognosticator in HF patients, better than other per-beat measures, which may be simpler but partial or incomplete descriptors of LV output. SVI, therefore, should be considered for the routine echocardiographic evaluation of patients hospitalized with HF to predict prognosis.
评估心力衰竭（HF）住院患者的左心室（LV）输出量对于确定预后很重要。尽管超声心动图 LV 射血分数（EF）通常用于此目的，但它的预后价值有限。在这项研究中，将 LV-EF 与其他每搏测量的 LV 输出量进行了比较，包括非指数化的每搏量（SV）、SV 指数（SVI）、射血距离（SD）、射血时间（ET）和流量（FR），以确定预测 HF 住院患者全因死亡率的最佳指标。研究了最终连续 350 名因 HF 住院并在住院期间接受超声心动图检查的患者。在中位随访 2.7 年后，有 163 名患者死亡。在随访中死亡的患者 SD、SVI 和 SV 较低，但 ET、FR 和 LV-EF 较高。多变量分析显示，只有年龄、收缩压、慢性肾脏病、慢性阻塞性肺疾病、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的使用以及 SVI 与预后显著相关[ SVI 的 HR 为 1.13（1.04-1.22），P=0.003]。特别是，SVI 每降低 5ml/m，全因死亡率的风险增加 13%。SVI 是 HF 患者的强大预后指标，优于其他每搏测量指标，后者可能更简单，但只是 LV 输出的部分或不完全描述。因此，应考虑在 HF 住院患者的常规超声心动图评估中使用 SVI 来预测预后。
