Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
ESC Heart Fail. 2020 Oct;7(5):3067-3074. doi: 10.1002/ehf2.12933. Epub 2020 Aug 10.
The area of the pupil can be used as an indicator of autonomic function. However, the relation between pupil area and prognosis in heart failure (HF) patients remains unclear. This study was performed to examine whether pupil area can be used as a prognostic indicator in patients with HF.
This retrospective review was performed in 870 consecutive patients (mean age: 67.0 ± 14.1 years, 37.0% women) hospitalized for acute HF. Pupil area was measured with a pupilometer at least 7 days after hospitalization for HF. The primary endpoint was all-cause mortality, and the secondary endpoint was readmission due to HF. A total of 131 patients died, and 328 patients were readmitted because of HF over a median follow-up of 1.9 (interquartile range: 1.0-3.7 years) years. After adjustment for several pre-existing prognostic factors, including Seattle Heart Failure Score (SHFS), pupil area was shown to be independently associated with all-cause mortality (hazard ratio: 0.72; 95% confidence interval: 0.59-0.88; P = 0.001) and readmission due to HF (hazard ratio: 0.82; 95% confidence interval: 0.73-0.93; P = 0.003). Addition of pupil area to SHFS significantly increased the area under the receiver-operating characteristic curve for all-cause mortality (0.69 vs. 0.72, respectively; P = 0.034).
Pupil area is an independent predictor of all-cause mortality and readmission due to HF and adds prognostic information to SHFS in patients with HF. The results presented here suggest that pupil area may be useful as a prognostic marker in patients with HF.
瞳孔面积可作为自主功能的指标。然而，在心力衰竭（HF）患者中，瞳孔面积与预后的关系尚不清楚。本研究旨在探讨瞳孔面积是否可作为 HF 患者的预后指标。
本回顾性研究纳入了 870 例连续住院的急性 HF 患者（平均年龄：67.0±14.1 岁，37.0%为女性）。至少在 HF 住院后 7 天使用瞳孔计测量瞳孔面积。主要终点为全因死亡率，次要终点为 HF 再入院。中位随访 1.9 年（四分位距：1.0-3.7 年）期间，共 131 例患者死亡，328 例患者因 HF 再入院。在校正了西雅图心力衰竭评分（SHFS）等多种预先存在的预后因素后，瞳孔面积与全因死亡率（风险比：0.72；95%置信区间：0.59-0.88；P=0.001）和 HF 再入院（风险比：0.82；95%置信区间：0.73-0.93；P=0.003）独立相关。将瞳孔面积加入 SHFS 后，全因死亡率的受试者工作特征曲线下面积显著增加（分别为 0.69 和 0.72，P=0.034）。
瞳孔面积是全因死亡率和 HF 再入院的独立预测因子，并为 HF 患者的 SHFS 提供了预后信息。本研究结果表明，瞳孔面积可能是 HF 患者有用的预后标志物。
