右心室收缩储备在低负荷运动中的作用对预测心力衰竭再入院的影响。
Role of the right ventricular contractile reserve during low-load exercise in predicting heart failure readmission.
机构信息
Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, Japan.
Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, Japan.
出版信息
J Cardiol. 2023 Jul;82(1):43-50. doi: 10.1016/j.jjcc.2023.03.001. Epub 2023 Mar 8.
BACKGROUND
Exercise intolerance in patients with heart failure (HF) increases HF-associated readmission, and right ventricular (RV) contractile reserve assessed by low-load exercise stress echocardiography (ESE) is associated with exercise intolerance. This study investigated the impact of RV contractile reserve evaluated by low-load ESE on HF readmission.
METHODS
We prospectively examined 81 consecutive patients hospitalized for HF who underwent low-load ESE under a stabilized HF condition between May 2018 and September 2020. We performed a 25-W low-load ESE and defined RV contractile reserve as the increment in RV systolic velocity (RV s'). The primary outcome was hospital readmission. Incremental values of the change in RV s' over a readmission risk (RR) score were analyzed using the receiver operating characteristic (ROC) area under the curve; internal validation using bootstrapping was performed. The association between RV contractile reserve and HF readmission was illustrated with the Kaplan-Meier curve.
RESULTS
Eighteen (22 %) patients were readmitted due to worsening HF during the observation period (median 15.6 months). The cut-off value of 0.68 cm/s for the change in RV s' to predict HF readmission with the ROC curve analysis indicated good sensitivity (100 %) and specificity (76.2 %). The discriminatory ability for HF readmission was significantly improved by adding the change in RV s' to the RR score (p = 0.006), and the c-statistic using the bootstrap method was 0.92. The cumulative survival rate free of HF readmission was significantly lower in patients with reduced-RV contractile reserve (log-rank test, p < 0.001).
CONCLUSIONS
The change in RV s' during low-load exercise had an incremental prognostic value for predicting HF readmission. The results demonstrated the loss of RV contractile reserve assessed by low-load ESE was associated with HF readmission.
背景
心力衰竭（HF）患者的运动不耐受会增加 HF 相关再入院，通过低负荷运动超声心动图（ESE）评估的右心室（RV）收缩储备与运动不耐受相关。本研究旨在探讨低负荷 ESE 评估的 RV 收缩储备对 HF 再入院的影响。
方法
我们前瞻性检查了 2018 年 5 月至 2020 年 9 月期间在稳定 HF 状态下接受低负荷 ESE 的 81 例连续住院 HF 患者。我们进行了 25-W 低负荷 ESE，并将 RV 收缩速度（RV s'）的增加定义为 RV 收缩储备。主要结局是医院再入院。使用接收者操作特征（ROC）曲线下面积分析 RV s'变化超过再入院风险（RR）评分的增量值；使用自举法进行内部验证。RV 收缩储备与 HF 再入院的关系用 Kaplan-Meier 曲线表示。
结果
在观察期间，18 例（22%）患者因 HF 恶化而再次入院（中位时间 15.6 个月）。ROC 曲线分析显示，RV s'变化的截断值为 0.68cm/s，预测 HF 再入院的敏感性为 100%，特异性为 76.2%。通过将 RV s'的变化添加到 RR 评分中，HF 再入院的判别能力显著提高（p=0.006），bootstrap 方法的 c 统计量为 0.92。低 RV 收缩储备患者的 HF 再入院无事件生存率显著降低（对数秩检验，p<0.001）。
结论
低负荷运动时 RV s'的变化对预测 HF 再入院具有增量预后价值。结果表明，低负荷 ESE 评估的 RV 收缩储备丧失与 HF 再入院相关。
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