Kaler I Gusti Bagus Putu Suwarjana, Wibhuti Ida Bagus Rangga, Wiryawan I Nyoman, Lestari A A Wiradewi
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia.
Department of Clinical Pathology, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia.
J Cardiovasc Echogr. 2024 Apr-Jun;34(2):63-71. doi: 10.4103/jcecho.jcecho_70_23. Epub 2024 Jun 28.
The postacute heart failure (AHF) rehospitalization rate is attributed to persistent hemodynamic congestion despite clinical improvement. Peak atrial longitudinal strain (PALS), utilizing speckle tracking echocardiography technology, shows potential in post-AHF prognosis. Meanwhile, N-terminal pro-hormone brain natriuretic peptide (NT-proBNP) remains a known biomarker of intracardiac congestion.
This study aimed to determine the relationship between predischarge PALS and NT-proBNP as predictors of major adverse cardiac event (MACE) in patients after AHF hospitalization.
This study is a prospective cohort study, conducted in Prof. Dr. I G.N.G Ngoerah Hospital, Bali, Indonesia.
The study included hospitalized AHF patients, collecting demographic data, comorbidities, therapies, and echocardiographic measures before discharge. Predischarge PALS and NT-proBNP were taken within 24 h before discharge. The main outcome was MACE, defined as rehospitalization and cardiovascular mortality within 90 days.
Comparative statistical analyses was done using independent -test for continuous variables (Mann-Whitney test for variables with abnormal distribution) and Chi-squared tests. Receiver operating characteristic (ROC) used in determining optimal threshold values of predischarge PALS and NT-proBNP as a predictor of MACE. Kaplan-Meier curves were employed to gauge event-free survival differences between these cohorts. Then, independent Cox regression was used to identify the predictors of MACE.
The study enrolled 67 patients with varying ejection fraction (EF) (16 - heart failure with preserved ejection fraction, 10 - heart failure with mildly reduced ejection fraction, and 41 - heart failure with reduced ejection fraction; mean age: 56.88 ± 14.57 years). Over the 90-day follow-up, 21 patients (31.3%) encountered MACE. Both PALS (area under the curve [AUC] 0.816) and NT-proBNP (AUC 0.856) before discharge served as predictors of MACE. There was no significant AUC difference between ROC curves (area difference: 0.039, = 0.553). The regression model highlighted that PALS and NT-proBNP level before discharge acted as independent predictors of MACE, irrespective of EF, average E/e', or estimated predischarge pulmonary capillary wedge pressure.
Predischarge PALS is comparable to NT-proBNP levels as independent predictors of short-term MACE after AHF hospitalization.
急性心力衰竭（AHF）再住院率归因于尽管临床症状有所改善但仍存在持续性血流动力学充血。利用斑点追踪超声心动图技术测量的心房纵向应变峰值（PALS）在AHF后的预后评估中显示出潜力。同时，N末端脑钠肽前体（NT-proBNP）仍然是心内充血的已知生物标志物。
本研究旨在确定出院前PALS与NT-proBNP之间的关系，作为AHF住院患者主要不良心脏事件（MACE）的预测指标。
本研究是一项前瞻性队列研究，在印度尼西亚巴厘岛的I G.N.G Ngoerah教授医院进行。
该研究纳入了住院的AHF患者，收集了人口统计学数据、合并症、治疗方法以及出院前的超声心动图测量数据。出院前PALS和NT-proBNP在出院前24小时内采集。主要结局是MACE，定义为90天内再住院和心血管死亡。
采用独立样本t检验（对分布异常的变量采用Mann-Whitney检验）和卡方检验进行比较统计分析。采用受试者工作特征曲线（ROC）确定出院前PALS和NT-proBNP作为MACE预测指标的最佳阈值。采用Kaplan-Meier曲线评估这些队列之间无事件生存差异。然后，使用独立Cox回归确定MACE的预测因素。
该研究纳入了67例射血分数（EF）各异的患者（16例射血分数保留的心力衰竭患者，10例射血分数轻度降低的心力衰竭患者，41例射血分数降低的心力衰竭患者；平均年龄：56.88±14.57岁）。在90天的随访中，21例患者（31.3%）发生了MACE。出院前的PALS（曲线下面积[AUC]为0.816）和NT-proBNP（AUC为0.856）均可作为MACE的预测指标。ROC曲线之间的AUC差异无统计学意义（面积差异：0.039，P = 0.553）。回归模型强调，出院前的PALS和NT-proBNP水平是MACE的独立预测因素，与EF、平均E/e'或出院前估计的肺毛细血管楔压无关。
出院前PALS作为AHF住院后短期MACE的独立预测指标，与NT-proBNP水平相当。
