Chan Wei Xuan, Kaura Amit, Mulla Abdulrahim, Papadimitriou Dimitri, Glampson Benjamin, Mayer Erik, Shah Anoop S V, Mayet Jamil, Yap Choon Hwai
Department of Bioengineering, Imperial College London, London, United Kingdom.
National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom.
Front Cardiovasc Med. 2024 May 9;11:1349338. doi: 10.3389/fcvm.2024.1349338. eCollection 2024.
Ejection fraction (EF) is widely used to evaluate heart function during heart failure (HF) due to its simplicity compared but it may misrepresent cardiac function during ventricular hypertrophy, especially in heart failure with preserved EF (HFpEF). To resolve this shortcoming, we evaluate a correction factor to EF, which is equivalent to computing EF at the mid-wall layer (without the need for mid-layer identification) rather than at the endocardial surface, and thus better complements other complex metrics.
The retrospective cohort data was studied, consisting of 2,752 individuals (56.5% male, age 69.3 ± 16.4 years) admitted with a request of a troponin test and undergoing echocardiography as part of their clinical assessment across three centres. Cox-proportional regression models were constructed to compare the adjusted EF (EFa) to EF in evaluating risk of heart failure admissions.
Comparing HFpEF patients to non-HF cases, there was no significant difference in EF (62.3 ± 7.6% vs. 64.2 ± 6.2%, = 0.79), but there was a significant difference in EFa (56.6 ± 6.4% vs. 61.8 ± 9.9%, = 0.0007). Both low EF and low EFa were associated with a high HF readmission risk. However, in the cohort with a normal EF (EF ≥ 50%), models using EFa were significantly more associative with HF readmissions within 3 years, where the leave one out cross validation ROC analysis showed a 18.6% reduction in errors, and Net Classification Index (NRI) analysis showed that risk increment classification of events increased by 12.2%, while risk decrement classification of non-events decreased by 16.6%.
EFa is associated with HF readmission in patients with a normal EF.
射血分数（EF）因其简便性而被广泛用于评估心力衰竭（HF）期间的心脏功能，但在心室肥厚时，尤其是在射血分数保留的心力衰竭（HFpEF）中，它可能会误判心脏功能。为了解决这一缺点，我们评估了一个EF校正因子，该因子相当于在中层（无需识别中层）而非心内膜表面计算EF，从而更好地补充其他复杂指标。
研究回顾性队列数据，该数据由2752名个体（56.5%为男性，年龄69.3±16.岁）组成，这些个体因肌钙蛋白检测需求入院，并在三个中心接受超声心动图检查作为临床评估的一部分。构建Cox比例回归模型，以比较校正后的EF（EFa）与EF在评估心力衰竭入院风险方面的差异。
将HFpEF患者与非HF病例进行比较，EF无显著差异（62.3±7.6%对64.2±6.2%，P=0.79），但EFa有显著差异（56.6±6.4%对61.8±9.9%，P=0.0007）。低EF和低EFa均与高HF再入院风险相关。然而，在EF正常（EF≥50%）的队列中，使用EFa的模型在3年内与HF再入院的关联性显著更强，其中留一法交叉验证ROC分析显示误差减少了18.6%，净分类指数（NRI）分析显示事件的风险增加分类增加了12.2%，而非事件的风险降低分类减少了16.6%。
EFa与EF正常患者的HF再入院相关。
