Jentzer Jacob C, Lee Eunjung, Attia Zachi, Hillerson Dustin, Kane Garvan C, Lopez-Jimenez Francisco, Noseworthy Peter A, Friedman Paul A, Oh Jae K
Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA.
J Am Heart Assoc. 2025 Mar 4;14(5):e037839. doi: 10.1161/JAHA.124.037839. Epub 2025 Feb 19.
Left ventricular diastolic dysfunction (LVDD) predicts mortality in patients in cardiac intensive care units. An artificial intelligence enhanced ECG (AIECG) algorithm can predict LVDD and mortality in general populations but has not been examined in cardiac intensive care units.
This historical cohort study included consecutive adults admitted to Mayo Clinic cardiac intensive care unit from 2007 to 2018 with an admission AIECG. The AIECG assigned the LVDD grade (0-3). Medial mitral E/e' ratio >15 on transthoracic echocardiogram (TTE) defined elevated filling pressures. In-hospital and 1-year mortality was evaluated, before and after multivariable adjustment.
We included 11 868 patients (median age 69.5 years, 37.7% female); 48% had heart failure and 44% had acute coronary syndromes. AIECG LVDD grade was 0 (normal), 33%; 1, 7%; 2, 39%; and 3, 21%. In-hospital and 1-year mortality increased in each higher AIECG LVDD grade. After adjustment, each higher AIECG LVDD grade was associated with higher in-hospital (adjusted odds ratio [OR], 1.22 [95% CI, 1.13-1.32]) and 1-year mortality (adjusted hazard ratio [HR], 1.23 [95% CI, 1.19-1.29]); this persisted after adjustment for TTE measurements. Patients with grade 2 or 3 LVDD by AIECG and medial mitral E/e' ratio >15 by TTE had the highest in-hospital (adjusted OR, 2.54 [95% CI, 1.69-3.88]) and 1-year (adjusted HR, 2.03 [95% CI, 1.65-2.48]) mortality, whereas patients meeting either of these criteria had similar, elevated mortality.
The AIECG LVDD grade was strongly associated with in-hospital and 1-year mortality in patients in cardiac intensive care units, even after adjusting for clinical variables and TTE measurements. Patients with concordant AIECG and TTE for elevated filling pressures were at highest risk.
左心室舒张功能障碍（LVDD）可预测心脏重症监护病房患者的死亡率。一种人工智能增强型心电图（AIECG）算法能够预测普通人群中的LVDD和死亡率，但尚未在心脏重症监护病房中进行检验。
这项历史性队列研究纳入了2007年至2018年连续入住梅奥诊所心脏重症监护病房且入院时进行了AIECG检查的成年人。AIECG确定LVDD分级（0 - 3级）。经胸超声心动图（TTE）测得的二尖瓣E/e'比值内侧>15定义为充盈压升高。在多变量调整前后评估住院期间和1年死亡率。
我们纳入了11868例患者（中位年龄69.5岁，37.7%为女性）；48%患有心力衰竭，44%患有急性冠状动脉综合征。AIECG LVDD分级为0级（正常）的占33%；1级占7%；2级占39%；3级占21%。AIECG LVDD分级越高，住院期间和1年死亡率越高。调整后，AIECG LVDD分级每升高一级，与更高的住院期间死亡率（调整后的比值比[OR]，1.22[95%CI，1.13 - 1.32]）和1年死亡率（调整后的风险比[HR]，1.23[95%CI，1.19 - 1.29]）相关；在对TTE测量值进行调整后，这种相关性依然存在。AIECG显示为2级或3级LVDD且TTE测得的二尖瓣E/e'比值内侧>15的患者住院期间死亡率最高（调整后的OR，2.54[95%CI，1.69 - 3.88]），1年死亡率最高（调整后的HR，2.03[95%CI，1.65 - 2.48]）；而符合这两个标准之一的患者死亡率也同样升高。
即使在对临床变量和TTE测量值进行调整后，AIECG LVDD分级仍与心脏重症监护病房患者的住院期间和1年死亡率密切相关。AIECG和TTE显示充盈压升高一致的患者风险最高。
