超声心动图充血分级对伴或不伴心房颤动的射血分数保留的心力衰竭患者的预后影响

Prognostic Impact of Echocardiographic Congestion Grade in HFpEF With and Without Atrial Fibrillation.

作者信息

Abe Haruhiko, Kosugi Shumpei, Ozaki Tatsuhisa, Mishima Tsuyoshi, Date Motoo, Ueda Yasunori, Uematsu Masaaki, Tamaki Shunsuke, Yano Masamichi, Hayashi Takaharu, Nakagawa Akito, Nakagawa Yusuke, Yamada Takahisa, Yasumura Yoshio, Dohi Tomoharu, Suna Shinichiro, Hikoso Shungo, Nakatani Daisaku, Koretsune Yukihiro, Sakata Yasushi

机构信息

Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan.

Division of Cardiology, Osaka General Medical Center, Osaka, Japan.

出版信息

JACC Asia. 2022 Jan 18;2(1):73-84. doi: 10.1016/j.jacasi.2021.10.012. eCollection 2022 Feb.

BACKGROUND

Atrial fibrillation (AF) is common in heart failure with preserved ejection fraction (HFpEF).

OBJECTIVES

This study aimed to investigate the prognostic value of echocardiographic markers of congestion that can be applied to both AF and patients without AF with HFpEF.

METHODS

We conducted a multicenter study of 505 patients with HFpEF admitted to hospitals for acute decompensated heart failure. The ratio of early diastolic transmitral flow velocity to mitral annulus velocity (E/e'), the tricuspid regurgitation peak velocity, and the collapsibility of the inferior vena cava were obtained at discharge. Congestion was determined by echocardiography if any one of E/e' ≥14 (E/e' ≥11 for AF), tricuspid regurgitation peak velocity ≥2.8 m/s, or inferior vena cava collapsibility <50% was positive. We classified patients into grade A, grade B, and grade C according to the number of positive congestion indices. The primary endpoint was the composite of cardiovascular death and heart failure hospitalization.

RESULTS

During the follow-up period (median: 373 days), 162 (32%) patients experienced the primary endpoint. Grade C patients had a higher risk for the primary endpoint than grade A (HR: 2.98; 95% CI: 1.97-4.52) and grade B patients (HR: 1.92; 95% CI: 1.29-2.86) (log-rank < 0.0001). Echocardiographic congestion grade improved the predictive value when added to the age, sex, New York Heart Association functional class, and N-terminal pro-B-type natriuretic peptide, not only in sinus rhythm (Uno C-statistic: 0.670 vs 0.655) but in AF (Uno C-statistic: 0.667 vs 0.639).

CONCLUSIONS

Echocardiographic congestion grade has prognostic value in patients with HFpEF with and without AF.

背景

心房颤动（AF）在射血分数保留的心力衰竭（HFpEF）中很常见。

目的

本研究旨在探讨可应用于AF和无AF的HFpEF患者的充血超声心动图标志物的预后价值。

方法

我们对505例因急性失代偿性心力衰竭入院的HFpEF患者进行了一项多中心研究。出院时获得舒张早期二尖瓣血流速度与二尖瓣环速度之比（E/e'）、三尖瓣反流峰值速度和下腔静脉塌陷度。如果E/e'≥14（AF患者为E/e'≥11）、三尖瓣反流峰值速度≥2.8 m/s或下腔静脉塌陷度<50%中的任何一项为阳性，则通过超声心动图确定充血情况。我们根据充血指数阳性的数量将患者分为A组、B组和C组。主要终点是心血管死亡和心力衰竭住院的复合终点。

结果

在随访期间（中位数：373天），162例（32%）患者达到主要终点。C组患者发生主要终点的风险高于A组（HR：；95%CI：1.97 - 4.52）和B组患者（HR：1.92；95%CI：1.29 - 2.86）（对数秩检验<0.0001）。超声心动图充血分级在加入年龄、性别、纽约心脏协会功能分级和N末端B型利钠肽原后，不仅在窦性心律（Uno C统计量：0.670对0.655）中，而且在AF（Uno C统计量：0.667对0.639）中都提高了预测价值。