Nagumo Sakura, Ebato Mio, Tsujiuchi Miki, Mizukami Takuya, Maezawa Hideyuki, Omura Ayumi, Kubota Megumi, Ohmi Maho, Numajiri Yuki, Kitai Hitomi, Toshida Tsutomu, Iso Yoshitaka, Suzuki Hiroshi
Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan.
ESC Heart Fail. 2024 Dec;11(6):4285-4295. doi: 10.1002/ehf2.15023. Epub 2024 Aug 26.
Left atrial (LA) volume index (LAVI) in chronic heart failure (HF) predicts cardiovascular outcomes. However, the association between LAVI reduction during acute decompensated HF (ADHF) and its prognostic potential is limited. We hypothesized that LA reverse remodelling (LARR) after ADHF therapy would be associated with better clinical outcomes.
This retrospective study analysed clinical outcomes and the LAVI reduction rate of 363 out of 861 patients hospitalized for ADHF who underwent two-point echocardiography at admission and discharge between January 2015 and December 2019. The mean age was 74.3 ± 13.6 years, and the mean ejection fraction (EF) was 38.9 ± 15.2%. The follow-up echocardiogram was performed 13.0 [9.5, 20] days after admission. As the median LAVI reduction rate was 7.02%, the LARR was defined as an LAVI reduction rate >7%.
During the 34.0 ± 20.2 months of follow-up, 117 patients (32.2%) reached the primary endpoint defined as cardiovascular death and rehospitalization for ADHF. Kaplan-Meier survival analysis showed that patients with LARR had a better prognosis. Multivariate analysis indicated that LARR was an independent predictor of cardiovascular events. Similar findings were observed in the subgroup analyses of patients with persistent/permanent atrial fibrillation and those with non-HF with reduced EF. Among patients who were brain natriuretic peptide (BNP) responders, defined as a relative reduction of >70% in BNP from admission to discharge, non-LARR was observed in 41.6%. BNP responders without LARR experienced worse prognoses.
LARR in the early vulnerable phase after hospitalization for ADHF was associated with better long-term clinical outcomes.
慢性心力衰竭（HF）患者的左心房（LA）容积指数（LAVI）可预测心血管结局。然而，急性失代偿性心力衰竭（ADHF）期间LAVI降低与其预后潜力之间的关联有限。我们假设ADHF治疗后的左心房逆向重构（LARR）与更好的临床结局相关。
这项回顾性研究分析了2015年1月至2019年12月期间因ADHF住院并在入院和出院时接受两点超声心动图检查的861例患者中的363例患者的临床结局和LAVI降低率。平均年龄为74.3±13.6岁，平均射血分数（EF）为38.9±15.2%。入院后13.0[9.5,20]天进行随访超声心动图检查。由于LAVI降低率的中位数为7.02%，LARR定义为LAVI降低率>7%。
在34.0±20.2个月的随访期间，117例患者（32.2%）达到了定义为心血管死亡和因ADHF再次住院的主要终点。Kaplan-Meier生存分析表明，LARR患者的预后更好。多变量分析表明，LARR是心血管事件的独立预测因素。在持续性/永久性心房颤动患者和射血分数降低的非HF患者的亚组分析中也观察到了类似的结果。在脑钠肽（BNP）反应者（定义为从入院到出院BNP相对降低>70%）中，41.6%未观察到LARR。没有LARR的BNP反应者预后较差。
ADHF住院后早期易损阶段的LARR与更好的长期临床结局相关。
