Antit Saoussen, Bousnina Sabrine, Fathi Mawa, Fekih Ridha, Boussabeh Elhem, Zakhama Lilia
University of Tunis El Manar, Faculty of Medicine of Tunis, Department of Cardiology, Interior Security Forces Hospital, La Marsa, Tunisia.
J Saudi Heart Assoc. 2024 May 8;36(1):42-52. doi: 10.37616/2212-5043.1373. eCollection 2024.
Type 1 cardiorenal syndrome (CRS) is defined as acute decompensated heart failure (AHF) leading to secondary acute kidney injury. Few studies have evaluated the reliability of transthoracic echocardiography (TTE) in assessing outcomes in patients with type 1 CRS. We sought to identify echocardiographic predictors of outcomes (death and rehospitalization) in patients with type 1 CRS.
This was a prospective longitudinal monocentric study, conducted from December 2020 to December 2022 in the cardiology department of the Internal Security Forces Hospital in Marsa, Tunisia. 68 patients with type 1 CRS were included prospectively. Physical, biological, and echocardiographic data were collected during the index hospitalization and at 3 and 6 months of follow-up.
The mean age was 69 ± 10.1 years with a male predominance (72.0%). The mortality rate during initial hospitalization for AHF was 11.7%. The all-cause mortality rate at six months was 22.0%. The rehospitalization rate was 38.0%. Severe tricuspid regurgitation (p = 0.031), the subaortic velocity time integral (LVOT-VTI) with a cut-off value of 16, a sensitivity (Se) of 65%, and a specificity (Sp) of 85% (Area under the curve (AUC) = 0.818, p < 0.001), the right ventricular fractional area change (RV-FAC) with a cut-off value of 16, a Se of 60% and a Sp of 81% (AUC = 0.775, p < 0.001) were independent predictors of the cumulative rates of rehospitalization and mortality at six months. Left ventricular ejection fraction (LVEF) < 35% (HR = 0.828, 95% CI: 0.689-0.995, p = 0.044) and the RV-FAC (HR = 0.564, 95% CI: 0.361-0.881, p = 0.012) were independent predictors of all-cause mortality. LVOT-VTI (AUC = 0.766, p < 0.001) was a significantly independent predictor of rehospitalization.
This study confirmed that type 1 CRS is associated with a poor prognosis. LVEF, LVOT-VTI, and RV-FAC are simple, reproducible, and sensitive ultrasound parameters for predicting outcomes in patients with type 1 CRS.
1型心肾综合征（CRS）定义为急性失代偿性心力衰竭（AHF）导致继发性急性肾损伤。很少有研究评估经胸超声心动图（TTE）在评估1型CRS患者预后方面的可靠性。我们试图确定1型CRS患者预后（死亡和再住院）的超声心动图预测因素。
这是一项前瞻性纵向单中心研究，于2020年12月至2022年12月在突尼斯马尔萨的内部安全部队医院心内科进行。前瞻性纳入68例1型CRS患者。在首次住院期间以及随访3个月和6个月时收集体格、生物学和超声心动图数据。
平均年龄为69±10.1岁，男性占主导（72.0%）。AHF首次住院期间的死亡率为11.7%。6个月时的全因死亡率为22.0%。再住院率为38.0%。严重三尖瓣反流（p = 0.031）、主动脉瓣下速度时间积分（LVOT-VTI），临界值为16，灵敏度（Se）为65%，特异度（Sp）为85%（曲线下面积（AUC）= 0.818，p < 0.001）、右心室面积变化分数（RV-FAC），临界值为16，Se为60%，Sp为81%（AUC = 0.775，p < 0.001）是6个月时再住院和死亡率累积率的独立预测因素。左心室射血分数（LVEF）< 35%（HR = 0.828，95%置信区间：0.689 - 0.995；p = 0.044）和RV-FAC（HR = 0.564，95%置信区间：0.361 - 0.881；p = 0.012）是全因死亡率的独立预测因素。LVOT-VTI（AUC = 0.766，p < 0.001）是再住院的显著独立预测因素。
本研究证实1型CRS与不良预后相关。LVEF、LVOT-VTI和RV-FAC是预测1型CRS患者预后的简单、可重复且敏感的超声参数。
