Anastasio Fabio, Testa Marzia, Ferreri Cinzia, Rossi Arianna, Ruocco Gaetano, Feola Mauro
Cardiology Division, Regina Montis Regalis Hospital, 12084 Cuneo, Italy.
Department of Geriatry, University of Turin, 10123 Turin, Italy.
J Clin Med. 2022 Jun 17;11(12):3507. doi: 10.3390/jcm11123507.
Background: The role of arterial stiffness in the pathogenesis and clinical outcome of heart failure (HF) patients has to be clarified. The aim of this study was to evaluate the prognostic role of arterial stiffness in HF patients discharged after acute episode of decompensation by evaluating cut-off values for clinical assessment. Methods: Patients admitted for decompensated heart failure (ADHF) underwent pre-discharge evaluation. Arterial stiffness was measured by aortic pulse wave velocity (aPWV), augmentation index (AIx75) and stiffness index (β0). Patients were also evaluated after discharge for a variable follow-up time. Results: We observed 199 patients (male 61.3%, age 76.2 ± 10.7 years) after discharge for a median of 437 days (IQR 247-903), 69 (34.7%) patients suffered HF with preserved ejection fraction (HFpEF), 45 (22.6%) patients experienced HF with mid-range ejection fraction (HFmEF) and 85 (42.7%) reported an HF with reduced ejection fraction (HFrEF). After the adjustment for principal confounders, aPWV, AIx75 and β0 were inversely correlated with free-event survival (p = 0.006, p < 0.001, p = 0.001): only β0 was inversely correlated with overall survival (p = 0.03). Analysing the threshold, overall survival was inversely correlated with β0 ≥3 (HR 2.1, p = 0.04) and free-event survival was inversely correlated with aPWV ≥10 m/s (HR 1.7, p = 0.03), AIx75 ≥ 25 (HR 2.4, p < 0.001), and β0 ≥ 3 (HR 2.0, p = 0.009). Dividing HF patients for LV ejection fraction, β0 and AIx75 appeared to be accurate prognostic predictors among the three different classes according to free-event survival. Conclusions: The non-invasive measurements of arterial stiffness proved to be strong prognostic parameters in HF patients discharged after an acute HF decompensation.
动脉僵硬度在心力衰竭（HF）患者发病机制及临床结局中的作用有待阐明。本研究旨在通过评估临床评估的临界值，来评价动脉僵硬度在急性失代偿发作后出院的HF患者中的预后作用。方法：因失代偿性心力衰竭（ADHF）入院的患者接受出院前评估。通过主动脉脉搏波速度（aPWV）、增强指数（AIx75）和僵硬度指数（β0）测量动脉僵硬度。患者出院后还进行了不同随访时间的评估。结果：我们观察了199例患者（男性占61.3%，年龄76.2±10.7岁），出院后中位随访时间为437天（四分位间距247 - 903天），69例（34.7%）患者为射血分数保留的心力衰竭（HFpEF），45例（22.6%）患者为射血分数中等范围的心力衰竭（HFmEF），85例（42.7%）报告为射血分数降低的心力衰竭（HFrEF）。在对主要混杂因素进行校正后，aPWV、AIx75和β0与无事件生存呈负相关（p = 0.006，p < 0.001，p = 0.001）：只有β0与总生存呈负相关（p = 0.03）。分析临界值时，总生存与β0≥3呈负相关（HR 2.1，p = 0.04），无事件生存与aPWV≥10 m/s（HR 1.7，p = 0.03）、AIx75≥25（HR 2.4，p < 0.001）以及β0≥≥3（HR 2.0，p = 0.009）呈负相关。根据左心室射血分数对HF患者进行分组，β0和AIx75在根据无事件生存划分的三种不同类型患者中似乎是准确的预后预测指标。结论：在急性HF失代偿后出院的HF患者中，动脉僵硬度的非侵入性测量被证明是强有力的预后参数。
