Kawaji Tetsuma, Kaneda Kazuhisa, Yaku Hidenori, Bao Bingyuan, Hojo Shun, Tezuka Yuji, Matsuda Shintaro, Shiomi Hiroki, Kato Masashi, Yokomatsu Takafumi, Miki Shinji, Ono Koh
Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan.
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
ESC Heart Fail. 2025 Feb;12(1):101-109. doi: 10.1002/ehf2.15034. Epub 2024 Sep 27.
The mechanisms underlying the acute decompensation of heart failure (HF) remain unclear. The present study examined intracardiac dynamics during decompensated HF using echo-vector flow mapping.
Fifty patients admitted for decompensated HF were prospectively enrolled, and intracardiac energy loss (EL) was assessed by echo-vector flow mapping at admission (decompensated HF) and discharge (compensated HF). Outcome measures were average EL in the left ventricle (LV) in decompensated and compensated HF and were compared with those in 40 stable non-HF patients with cardiovascular diseases. The mean age of HF patients was 80.8 ± 12.4 years. The prevalence of both females and atrial fibrillation was 48.0%. The prevalence of HF with a reduced ejection fraction (<40%) (HFrEF) was 34.0%. The prevalence of decompensated HF classified into clinical scenario 1 was 33.3%. Blood pressure and NT-proBNP were significantly higher in decompensated HF than in compensated HF, while the ejection fraction (EF) was significantly lower. Average EL was significantly higher in compensated HF patients than in non-HF patients (40 mW/m·L vs. 26 mW/m·L, P = 0.047). A multivariable analysis identified age, systolic blood pressure, LVEF, and the absence of chronic obstructive pulmonary disease as independent risk factors for high LV-EL regardless of the presence of HF. Furthermore, average EL in HF patients was significantly higher under acute decompensated conditions than under compensated conditions (55 mE/m·L vs. 40 mE/m·L, [+18 mE/m·L, P = 0.03]). Higher EL under decompensated HF conditions was significant in non-HFrEF (+19 mW/m·L, P = 0.009) and clinical scenario 1 (+23 mW/m·L, P = 0.008). The multivariable analysis identified eGFR as an independent risk factor for a decrease in average LV-EL under decompensated conditions.
Energy inefficiency in LV was apparent even in stable HF patients and significant under acute decompensated conditions, particularly in HF with preserved EF and clinical scenario 1.
心力衰竭（HF）急性失代偿的潜在机制仍不清楚。本研究使用超声向量血流图检查失代偿性HF期间的心内动力学。
前瞻性纳入50例因失代偿性HF入院的患者，并在入院时（失代偿性HF）和出院时（代偿性HF）通过超声向量血流图评估心内能量损失（EL）。观察指标为失代偿性和代偿性HF患者左心室（LV）的平均EL，并与40例稳定的非HF心血管疾病患者进行比较。HF患者的平均年龄为80.8±12.4岁。女性和心房颤动的患病率均为48.0%。射血分数降低（< 40%）的HF（HFrEF）患病率为34.0%。分类为临床情况1的失代偿性HF患病率为33.3%。失代偿性HF患者的血压和NT-proBNP显著高于代偿性HF患者，而射血分数（EF）显著降低。代偿性HF患者的平均EL显著高于非HF患者（40 mW/m·L对26 mW/m·L，P = 0.047）。多变量分析确定年龄、收缩压、左心室射血分数和无慢性阻塞性肺疾病是高LV-EL的独立危险因素，无论是否存在HF。此外，HF患者在急性失代偿状态下的平均EL显著高于代偿状态（55 mE/m·L对40 mE/m·L，[+18 mE/m·L，P = 0.03]）。在非HFrEF（+19 mW/m·L，P = 0.009）和临床情况1（+23 mW/m·L，P = 0.008）中，失代偿性HF状态下较高的EL具有显著性。多变量分析确定估算肾小球滤过率（eGFR）是失代偿状态下平均LV-EL降低的独立危险因素。
即使在稳定的HF患者中，LV的能量低效也很明显，在急性失代偿状态下更为显著，尤其是在射血分数保留的HF和临床情况1中。
