Wang Shiqi, Chen Aiqi, Duan Xiaokai
General Department of Zhengzhou First People's Hospital, Zhengzhou, China.
Department of Cardiology, Hospital of Joint Logistic Support Force of the Chinese People's Liberation Army, Zhengzhou, China.
Front Cardiovasc Med. 2022 Jul 5;9:915918. doi: 10.3389/fcvm.2022.915918. eCollection 2022.
We sought to explore the significance of resting cardiac power/mass in predicting adverse outcome in patients with heart failure with preserved ejection fraction (HFpEF).
This prospective cohort study included patients with HFpEF and without significant valve disease or right ventricular dysfunction. Cardiac power was normalized to left ventricular (LV) mass and expressed in W/100 g of LV myocardium. Multivariate Cox regression analysis was used to evaluate the association between resting cardiac power/mass and composite endpoint, which included all-cause mortality and heart failure (HF) hospitalization.
A total of 2,089 patients were included in this study. After an average follow-up of 4.4 years, 612 (29.30%) patients had composite endpoint, in which 331 (15.84%) died and 391 (18.72%) experienced HF hospitalization. In multivariate Cox regression analysis, resting power/mass < 0.7 W/m was independently associated with composite endpoint, all-cause mortality, cardiovascular mortality and HF hospitalization, with hazard ratios (HR) of 1.309 [95% confidence interval (CI): 1.108-1.546, = 0.002], 1.697 (95%CI: 1.344-2.143, < 0.001), 2.513 (95%CI: 1.711-3.689, < 0.001), and 1.294 (95%CI: 1.052-1.592, = 0.015), respectively. For composite endpoint, cardiovascular mortality and HF hospitalization, the C statistic increased significantly when incorporating resting cardiac power/mass into a model with established risk factors. For composite endpoint, the continuous net reclassification index after adding resting cardiac power/mass in the original model with N-terminal pro-brain natriuretic peptide was 13.1% (95%CI: 2.9-21.6%, = 0.007), and the integrated discrimination index was 1.9% (95%CI: 0.8-3.2%, < 0.001).
Resting cardiac power determined by non-invasive echocardiography is independently associated with the risk of adverse outcomes in HFpEF patients and provides incremental prognostic information.
我们试图探讨静息心功率/质量在预测射血分数保留的心力衰竭（HFpEF）患者不良结局中的意义。
这项前瞻性队列研究纳入了无明显瓣膜疾病或右心室功能障碍的HFpEF患者。心功率以左心室（LV）质量进行标准化，并以每100g左心室心肌的瓦特数表示。采用多变量Cox回归分析来评估静息心功率/质量与复合终点之间的关联，复合终点包括全因死亡率和心力衰竭（HF）住院。
本研究共纳入2089例患者。平均随访4.4年后，612例（29.30%）患者出现复合终点，其中331例（15.84%）死亡，391例（18.72%）发生HF住院。在多变量Cox回归分析中，静息功率/质量<0.7W/m与复合终点、全因死亡率、心血管死亡率和HF住院独立相关，危险比（HR）分别为1.309[95%置信区间（CI）：1.108 - 1.546，P = 0.002]、1.697（95%CI：1.344 - 2.143，P < 0.001）、2.513（95%CI：1.711 - 3.689，P < 0.001）和1.294（95%CI：1.052 - 1.592，P = 0.015）。对于复合终点、心血管死亡率和HF住院，将静息心功率/质量纳入包含既定危险因素的模型时，C统计量显著增加。对于复合终点，在原有的含N末端脑钠肽前体的模型中加入静息心功率/质量后的连续净重新分类指数为13.1%（95%CI：2.9 - 21.6%，P = 0.007），综合判别指数为1.9%（95%CI：0.8 - 3.2%，P < 0.001）。
通过无创超声心动图测定的静息心功率与HFpEF患者的不良结局风险独立相关，并提供了额外的预后信息。
