回顾性评估超声心动图变量对射血分数保留型与射血分数降低型心力衰竭患者心力衰竭住院的预测作用：单中心经验。
Retrospective evaluation of echocardiographic variables for prediction of heart failure hospitalization in heart failure with preserved versus reduced ejection fraction: A single center experience.
机构信息
Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America.
Division of Cardiovascular Medicine, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America.
出版信息
PLoS One. 2020 Dec 22;15(12):e0244379. doi: 10.1371/journal.pone.0244379. eCollection 2020.
BACKGROUND
Limited data exist on the differential ability of variables on transthoracic echocardiogram (TTE) to predict heart failure (HF) readmission across the spectrum of left ventricular (LV) systolic function.
METHODS
We linked 15 years of TTE report data (1/6/2003-5/3/2018) at Beth Israel Deaconess Medical Center to complete Medicare claims. In those with recent HF, we evaluated the relationship between variables on baseline TTE and HF readmission, stratified by LVEF.
RESULTS
After excluding TTEs with uninterpretable diastology, 5,900 individuals (mean age: 76.9 years; 49.1% female) were included, of which 2545 individuals (41.6%) were admitted for HF. Diastolic variables augmented prediction compared to demographics, comorbidities, and echocardiographic structural variables (p < 0.001), though discrimination was modest (c-statistic = 0.63). LV dimensions and eccentric hypertrophy predicted HF in HF with reduced (HFrEF) but not preserved (HFpEF) systolic function, whereas LV wall thickness, NT-proBNP, pulmonary vein D- and Ar-wave velocities, and atrial dimensions predicted HF in HFpEF but not HFrEF (all interaction p < 0.10). Prediction of HF readmission was not different in HFpEF and HFrEF (p = 0.93).
CONCLUSIONS
In this single-center echocardiographic study linked to Medicare claims, left ventricular dimensions and eccentric hypertrophy predicted HF readmission in HFrEF but not HFpEF and left ventricular wall thickness predicted HF readmission in HFpEF but not HFrEF. Regardless of LVEF, diastolic variables augmented prediction of HF readmission compared to echocardiographic structural variables, demographics, and comorbidities alone. The additional role of medication adherence, readmission history, and functional status in differential prediction of HF readmission by LVEF category should be considered for future study.
背景
关于经胸超声心动图（TTE）各变量预测左心室收缩功能不同程度心力衰竭（HF）再入院的能力，相关数据有限。
方法
我们将贝斯以色列女执事医疗中心 15 年的 TTE 报告数据（2003 年 6 月 1 日至 2018 年 5 月 3 日）与完整的 Medicare 理赔数据相链接。对于近期有 HF 病史的患者，我们评估了基线 TTE 各变量与 HF 再入院的关系，并按 LVEF 进行分层。
结果
排除 TTE 中无法解释的舒张期数据后，共纳入 5900 例患者（平均年龄：76.9 岁；49.1%为女性），其中 2545 例（41.6%）因 HF 入院。与人口统计学因素、合并症和超声心动图结构变量相比，舒张期变量增强了预测能力（p<0.001），但区分度较小（c 统计量=0.63）。LV 尺寸和偏心性肥厚预测 HF 在心衰射血分数降低（HFrEF）但不保留（HFpEF）患者中，而 LV 壁厚度、NT-proBNP、肺静脉 D 和 Ar 波速度和心房大小则在心衰射血分数保留（HFpEF）但不保留（HFrEF）患者中预测 HF（所有交互 p<0.10）。HFpEF 和 HFrEF 患者 HF 再入院的预测结果无差异（p=0.93）。
结论
在这项与 Medicare 理赔数据相链接的单中心超声心动图研究中，LV 尺寸和偏心性肥厚预测 HFrEF 患者 HF 再入院，而 LV 壁厚度预测 HFpEF 患者 HF 再入院。无论 LVEF 如何，与超声心动图结构变量、人口统计学因素和合并症相比，舒张期变量均增强了 HF 再入院的预测能力。未来的研究应考虑药物依从性、再入院史和功能状态在通过 LVEF 分层预测 HF 再入院中的差异作用。
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