Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Am Soc Echocardiogr. 2022 Mar;35(3):287-294. doi: 10.1016/j.echo.2021.10.012. Epub 2021 Nov 9.
Although routine echocardiographic parameters such as ejection fraction are used to risk-stratify for death in patients referred for echocardiography, they have limited predictive value. The authors speculated that noninvasive hemodynamic echocardiographic data, assessing left ventricular filling pressure and output, stratified on the basis of the clinical Killip score, might have additive prognostic value on top of routine echocardiographic parameters. The authors created an echocardiographic correlate of this classification, using diastolic grade and stroke volume index (SVI) as indicators of pulmonary congestion and systemic perfusion, respectively, and evaluated the prognostic value of this correlate.
A retrospective study of consecutive patients (hospitalized or not) referred for echocardiography for a range of cardiac diagnoses in a tertiary medical center. A total of 556 patients in sinus rhythm who were evaluated by two sonographers, and reviewed by a single cardiologist, were included. Normal filling pressure and normal SVI (>35 mL/m) defined echocardiographic Killip (eKillip) class 1. Patients with pseudonormal or restrictive diastolic patterns and normal SVI were ascribed to eKillip class 2 or 3, respectively. A pseudonormal or restrictive diastolic pattern and a subnormal SVI defined eKillip class 4.
eKillip class 1 was present in 382 patients (68%); 115 (20%), 26 (5%), and 42 (7%) patients were in eKillip classes 2 to 4, respectively. Median follow-up time was 1,056 days (interquartile range, 729-1,390 days). A total of 105 deaths occurred. Univariate Cox regression analysis showed that eKillip class was associated with all-cause mortality; hazard ratios (HR) -2.73 (95% CI, 1.67-4.48), 3.19 (95% CI, 1.42-7.17), and 4.79 (95% CI, 2.58-8.89) for each eKillip class above 1 (P < .001). In a multivariate analysis adjusted for the Charlson comorbidity index, eKillip class remained independently associated with all-cause mortality (P = .04).
eKillip class was associated with all-cause mortality among all patients undergoing echocardiography at a tertiary hospital.
尽管射血分数等常规超声心动图参数可用于对接受超声心动图检查的患者进行死亡风险分层，但它们的预测价值有限。作者推测，基于临床 Killip 评分进行非侵入性血流动力学超声心动图数据评估左心室充盈压和输出，可以在常规超声心动图参数的基础上提供额外的预后价值。作者使用舒张分级和每搏输出量指数（SVI）分别作为肺充血和全身灌注的指标，创建了该分类的超声心动图相关性，并评估了该相关性的预后价值。
这是一项在三级医疗中心对因各种心脏诊断而接受超声心动图检查的连续患者（住院或不住院）进行的回顾性研究。共纳入了 556 名窦性节律患者，这些患者由两名超声心动图医师进行评估，并由一名心脏病专家进行了单一审查。正常充盈压和正常 SVI（>35mL/m）定义为超声心动图 Killip（eKillip）分级 1 级。具有假性正常或限制性舒张模式且 SVI 正常的患者分别被归类为 eKillip 分级 2 级或 3 级。假性正常或限制性舒张模式和 SVI 降低定义为 eKillip 分级 4 级。
eKillip 分级 1 级见于 382 例患者（68%）；eKillip 分级 2 级至 4 级分别见于 115 例（20%）、26 例（5%）和 42 例（7%）患者。中位随访时间为 1056 天（四分位距，729-1390 天）。共有 105 例死亡。单因素 Cox 回归分析显示，eKillip 分级与全因死亡率相关；每增加一个 eKillip 分级，风险比（HR）分别为 2.73（95%CI，1.67-4.48）、3.19（95%CI，1.42-7.17）和 4.79（95%CI，2.58-8.89）（P<.001）。在调整 Charlson 合并症指数的多因素分析中，eKillip 分级与全因死亡率仍显著相关（P=.04）。
在一家三级医院进行超声心动图检查的所有患者中，eKillip 分级与全因死亡率相关。
