Open Cardiovascular Medicine Journal最新文献

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Diastolic Dysfunction Criteria and Heart failure Readmission in Patients with Heart Failure and Reduced Ejection Fraction 心力衰竭和射血分数降低患者的舒张功能障碍标准和心力衰竭再入院

Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Open Cardiovascular Medicine Journal

Pub Date : 2023-03-29 DOI: 10.2174/18741924-v17-e230301-2022-9

Steven J. Lavine, Danielle Kelvas

Background: Advanced diastolic dysfunction (DDys) correlates with elevated LV filling pressures and predicts heart failure readmission (HF-R). As grade 2-3 DDys has predictive value for HF-R, and requires 2 of 3 criteria (left atrial volume index >34 ml/m2, E/e’>14, or tricuspid regurgitation velocity >2.8 m/s), we hypothesized that all 3 criteria would predict greater HF risk than any 2 criteria. Methods: In this single-center retrospective study that included 380 patients in sinus rhythm with HF and reduced ejection, we recorded patient characteristics, Doppler-echo, and HF-R with follow-up to 2167 days (median=1423 days; interquartile range=992-1821 days). Results: For grade 1 DDys (223 patients), any single criteria resulted in greater HF-R as compared to 0 criteria (HR=2.52, (1.56-3.88) p<0.0001) with an AUC (area under curve)=0.637, p<0.001. For grade 2 DDys (94 patients), there was greater HF-R for all 3 ( vs . 0 criteria: HR=4.0 (2.90-8.36), p<0.0001). There was greater HF-R for 3 vs any 2 criteria (HR=1.81, (1.10-3.39), p=0.0222). For all 3 criteria, there was moderate predictability for HF-R (AUC=0.706, p<0.0001) which was more predictive than any 2 criteria (AUC difference 0.057, (0.011-0.10), p=0.009). For grade 3 DDys (63 patients), E/A>2+2-3 criteria identified a subgroup with the greatest risk of HF-R (HR=5.03 (4.62-22.72), p<0.0001) compared with 0 DDys criteria with moderate predictability for 2-3 criteria (AUC=0.726, p<0.0001) exceeding E/A>2+0-1 criteria (AUC difference=0.120, (0.061-0.182), p<0.001). Conclusion: Increasing the number of abnormal criteria increased the risk and predictive value of HF-R for grade 1-3 DDys in patients with HF with reduced ejection fraction.

背景:晚期舒张功能障碍(DDys)与左室充盈压力升高相关，并预测心力衰竭再入院(HF-R)。由于2-3 dys级对HF- r有预测价值，并且需要3个标准中的2个(左心房容积指数34 ml/m2、E/ E 14或三尖瓣反流速度2.8 m/s)，我们假设这3个标准对HF风险的预测高于任何2个标准。方法:在这项单中心回顾性研究中，我们纳入了380例伴有心衰和射血减少的窦性心律患者，记录了患者的特征、多普勒回波和HF- r，随访2167天(中位=1423天;四分位数间距=992-1821天)。结果:对于1级dys(223例患者)，任何单一标准导致的HF-R均高于0标准(HR=2.52， (1.56-3.88) p<0.0001)， AUC(曲线下面积)=0.637,p<0.001)。对于2级dys(94例)，所有3例患者的HF-R都更高(vs。0标准:HR=4.0 (2.90-8.36)， p<0.0001)。3个标准的HF-R高于任何2个标准(HR=1.81， (1.10-3.39)， p=0.0222)。对于所有3个标准，HF-R具有中等可预测性(AUC=0.706, p<0.0001)，比任何2个标准更具预测性(AUC差0.057，(0.011-0.10)，p=0.009)。对于3级dys(63例患者)，E/A>2+2-3标准确定了HF-R风险最高的亚组(HR=5.03 (4.62-22.72)， p<0.0001)，与0个dys标准相比，2-3标准的可预测性中等(AUC=0.726, p<0.0001)超过E/A>2+0-1标准(AUC差异=0.120，(0.061-0.182)，p<0.001)。结论:增加异常标准的数量增加了1-3 dys级HF伴射血分数降低患者HF- r的风险和预测价值。

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