Huttin Olivier, Fraser Alan G, Lund Lars H, Donal Erwan, Linde Cecilia, Kobayashi Masatake, Erdei Tamas, Machu Jean-Loup, Duarte Kevin, Rossignol Patrick, Paulus Walter, Zannad Faiez, Girerd Nicolas
Inserm, Centre d'Investigations Cliniques-Plurithématique 1433, Inserm U1116, CHRU Nancy, Université de Lorraine, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux Louis Mathieu, Centre Hospitalier Universitaire de Nancy, 4 Rue du Morvan, Nancy, 54500, France.
ESC Heart Fail. 2021 Jun;8(3):1827-1839. doi: 10.1002/ehf2.13251. Epub 2021 Mar 3.
Echocardiographic predictors of outcomes in heart failure with preserved ejection fraction (HFpEF) have not been systematically or independently validated. We aimed at identifying echocardiographic predictors of cardiovascular events in a large cohort of patients with HFpEF and to validate these in an independent large cohort.
We assessed the association between echocardiographic parameters and cardiovascular outcomes in 515 patients with heart failure with preserved left ventricular (LV) ejection fraction (>50%) in the MEtabolic Road to DIAstolic Heart Failure (MEDIA) multicentre study. We validated out findings in 286 patients from the Karolinska-Rennes Prospective Study of HFpEF (KaRen). After multiple adjustments including N-terminal pro-brain natriuretic peptide (NT-proBNP), the significant predictors of death or cardiovascular hospitalization were pulmonary arterial systolic pressure > 40 mmHg, respiratory variation in inferior vena cava diameter > 0.5, E/e' > 9, and lateral mitral annular s' < 7 cm/s. The combination of these four variables differentiated patients with <10% vs. >35% 1 year risk. Adding these four echocardiographic variables on top of clinical variables and NT-proBNP yielded significant net reclassification improvement (33.8%, P < 0.0001) and increase in C-index (5.3%, a change from 72.2% to 77.5%, P = 0.015) of similar magnitude as the addition of NT-proBNP on top of clinical variables alone. In the KaRen cohort, these four variables yielded a similar improvement in net reclassification improvement (22.3%, P = 0.014) and C-index (4.0%, P = 0.029).
Use of four simple echocardiographic parameters (within the MEDIA echo score), indicative of pulmonary hypertension, elevated central venous pressure, LV diastolic dysfunction, and LV long-axis systolic dysfunction, independently predicted prognosis and improved risk stratification additionally to clinical variables and NT-proBNP in HFpEF. This finding was validated in an independent cohort.
射血分数保留的心力衰竭（HFpEF）患者预后的超声心动图预测指标尚未得到系统或独立验证。我们旨在确定一大群HFpEF患者中心血管事件的超声心动图预测指标，并在一个独立的大群体中对其进行验证。
在代谢途径致舒张性心力衰竭（MEDIA）多中心研究中，我们评估了515例左心室（LV）射血分数保留（>50%）的心力衰竭患者的超声心动图参数与心血管结局之间的关联。我们在卡罗林斯卡 - 雷恩HFpEF前瞻性研究（KaRen）的286例患者中验证了我们的发现。在进行包括N末端脑钠肽前体（NT-proBNP）在内的多次调整后，死亡或心血管住院的显著预测指标为肺动脉收缩压>40 mmHg、下腔静脉直径呼吸变化>0.5、E/e'>9以及二尖瓣外侧环s'<7 cm/s。这四个变量的组合可区分1年风险<10%与>35%的患者。在临床变量和NT-proBNP基础上加入这四个超声心动图变量可产生显著的净重新分类改善（33.8%，P<0.0001）以及C指数增加（5.3%，从72.2%变化至77.5%，P = 0.015），其幅度与仅在临床变量基础上加入NT-proBNP相似。在KaRen队列中，这四个变量在净重新分类改善（22.3%，P = 0.014）和C指数（4.0%，P = 0.029）方面产生了类似的改善。
使用四个简单的超声心动图参数（在MEDIA回声评分范围内），这些参数指示肺动脉高压、中心静脉压升高、左心室舒张功能障碍和左心室长轴收缩功能障碍，在HFpEF中除临床变量和NT-proBNP外，还能独立预测预后并改善风险分层。这一发现已在一个独立队列中得到验证。
