Chen Cong, Zhao Jie, Xue Ruicong, Liu Xiao, Zhu Wengen, Ye Min
Department of Cardiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Department of Cardiovascular Medicine, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, China.
Front Cardiovasc Med. 2022 Aug 18;9:961837. doi: 10.3389/fcvm.2022.961837. eCollection 2022.
Cardiac power-to-left ventricular mass (power/mass) is an index reflecting the muscular hydraulic pump capability of the heart, and the E/e' ratio is a specific indicator for identifying increased left ventricular filling pressure. Limited data exist regarding the prognostic value of incorporating power/mass and E/e' ratio in heart failure with preserved ejection fraction (HFpEF).
In total, 475 patients with HFpEF from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial with complete baseline echocardiography data were included in our analysis. Patients were categorized into four groups according to power/mass and E/e' ratio. The risk of outcomes was examined using Cox proportional hazards models and competing risk models.
Patients with low power/mass and high E/e' were more likely to be males (60.5%), with higher waist circumference, and had a higher prevalence of diabetes (52.1%), atrial fibrillation (50.4%), and lower estimated glomerular filtration rate (eGFR). Combined resting power/mass and E/e' have graded correlations with left ventricular (LV) dysfunction and clinical outcomes in patients with HFpEF. After multivariable adjustments, an integrative approach combining power/mass and E/e' remained to be a powerful prognostic predictor, with the highest HRs of clinical outcomes observed in patients with low power/mass and high E/e' (all-cause mortality: HR 3.45; 95% CI: 1.69-7.05; = 0.001; hospitalization for heart failure: HR 3.27; 95% CI: 1.60-6.67; = 0.001; and primary endpoint: HR 3.07; 95% CI: 1.73-5.42; < 0.001).
In patients with HFpEF, an echo-derived integrated approach incorporating resting power/mass and E/e' ratio remained to be a powerful prognosis predictor and may be useful to risk-stratify patients with this heterogeneous syndrome.
[https://clinicaltrials.gov], identifier [NCT00094302].
心脏功率与左心室质量之比（功率/质量）是反映心脏肌肉液压泵功能的指标，而E/e'比值是识别左心室充盈压升高的特定指标。关于在射血分数保留的心力衰竭（HFpEF）中纳入功率/质量和E/e'比值的预后价值的数据有限。
我们纳入了醛固酮拮抗剂治疗保留心功能心力衰竭（TOPCAT）试验中的475例HFpEF患者，这些患者有完整的基线超声心动图数据。根据功率/质量和E/e'比值将患者分为四组。使用Cox比例风险模型和竞争风险模型检查结局风险。
功率/质量低且E/e'高的患者更可能为男性（60.5%），腰围更大，糖尿病（52.1%）、心房颤动（50.4%）患病率更高，估计肾小球滤过率（eGFR）更低。静息状态下的功率/质量和E/e'联合与HFpEF患者的左心室（LV）功能障碍和临床结局呈分级相关。经过多变量调整后，将功率/质量和E/e'相结合的综合方法仍然是一个强大的预后预测指标，在功率/质量低且E/e'高的患者中观察到的临床结局风险比最高（全因死亡率：风险比3.45；95%置信区间：1.69 - 7.05；P = 0.001；因心力衰竭住院：风险比3.27；95%置信区间：1.60 - 6.67；P = 0.001；主要终点：风险比3.07；95%置信区间：1.73 - 5.42；P < 0.001）。
在HFpEF患者中，采用静息功率/质量和E/e'比值的超声心动图综合方法仍然是一个强大的预后预测指标，可能有助于对这种异质性综合征患者进行风险分层。
