射血分数轻度降低或降低的心力衰竭患者根据舒张功能指标进行风险分层。
Risk stratification according to diastolic function indices in heart failure patients with mildly reduced or reduced ejection fraction.
作者信息
Granot Yoav, Topilsky Yan, Sapir Orly, Zahler David, Flint Nir, Havakuk Ofer
机构信息
Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Weizman 6, Tel-Aviv, 6423906, Israel.
出版信息
Eur Heart J Open. 2023 Mar 10;3(2):oead020. doi: 10.1093/ehjopen/oead020. eCollection 2023 Mar.
AIMS
The aim of the study is to evaluate the risk of all-cause mortality or heart failure hospitalizations in ambulatory patients with heart failure with reduced and mildly reduced ejection fraction (HFrEF or HFmrEF) according to diastolic function indices. Diastolic dysfunction in HF is both common and associated with poor prognosis. However, specific cut-off values of diastolic function parameters for prognostication of hard outcomes in HF have not been conclusively established.
METHODS AND RESULTS
Analysis of full echocardiographic examination of consecutive ambulatory HFrEF and HFmrEF patients seen at a single tertiary hospital between 2010 and 2021 was retrospectively done. Data on all-cause mortality or heart failure hospitalizations were obtained from the electronic medical records and national mortality registry. Patients with > moderate left heart valvular dysfunction were excluded from the study. The final cohort included 4717 patients (75% males, median age 70 years interquartile range 61.3-78.4). After adjusting for clinical or echocardiographic variables, increased rates of mortality or HF hospitalizations were found when />10, left atrial volume index (LAVI) > 40 mL/m, E/A ratio < 0.6, deceleration time (DT) < 180 ms, peak E-wave velocity > 0.78 m/s, and sPAP > 26 mmHg. However, no significant difference in outcomes between near-normal and normal values of / (< 8 compared with 8-10) or LAVI (≤34 mL/m compared with LAVI 34-40 mL/m) was found.
CONCLUSION
In patients with HFmrEF and HFrEF, slightly abnormal diastolic indices were found to be associated with worse outcomes.
SUMMARY
We have demonstrated that in patients with heart failure with reduced and mildly reduced ejection fraction (HFrEF or HFmrEF), near-normal diastolic indices are associated with worse outcomes with the following cut-off values: max E-wave velocity > 0.78 m/s, / ratio > 10, a LAVi > 40 mL/m, DT > 180, E/A between 0.6 and 1.4, and a sPAP > 26 mmHg. Further research is needed to establish these suggested cut-off values.
目的
本研究旨在根据舒张功能指标评估射血分数降低和轻度降低的门诊心力衰竭患者（HFrEF或HFmrEF）的全因死亡率或心力衰竭住院风险。心力衰竭中的舒张功能障碍既常见又与预后不良相关。然而，尚未最终确定用于预测心力衰竭严重结局的舒张功能参数的特定临界值。
方法与结果
对2010年至2021年期间在一家三级医院连续就诊的门诊HFrEF和HFmrEF患者的完整超声心动图检查进行回顾性分析。从电子病历和国家死亡率登记处获取全因死亡率或心力衰竭住院的数据。左心瓣膜功能障碍程度>中度的患者被排除在研究之外。最终队列包括4717名患者（75%为男性，中位年龄70岁，四分位间距61.3 - 78.4）。在对临床或超声心动图变量进行调整后，发现当/ > 10、左心房容积指数（LAVI）> 40 mL/m²、E/A比值< 0.6、减速时间（DT）< 180 ms、E波峰值速度> 0.78 m/s和收缩期肺动脉压（sPAP）> 26 mmHg时，死亡率或心力衰竭住院率增加。然而，/（< 8与8 - 10相比）或LAVI（≤34 mL/m²与LAVI 34 - 40 mL/m²相比）接近正常和正常数值之间的结局无显著差异。
结论
在HFmrEF和HFrEF患者中，舒张指标轻度异常与更差的结局相关。
总结
我们已经证明，在射血分数降低和轻度降低的心力衰竭患者（HFrEF或HFmrEF）中，接近正常的舒张指标与更差的结局相关，具体临界值如下：E波峰值速度> 0.78 m/s、/比值> 10、左心房容积指数> 40 mL/m²、减速时间> 180、E/A在0.6至1.4之间以及收缩期肺动脉压> 26 mmHg。需要进一步研究来确定这些建议的临界值。
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