Patients with left ventricular ejection fraction greater than 58 % have fewer incidences of future acute decompensated heart failure admission and all-cause mortality.
Patients with left ventricular ejection fraction greater than 58 % have fewer incidences of future acute decompensated heart failure admission and all-cause mortality.
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DOI：
10.1007/s00380-015-0657-1
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发表时间：
2016-05
影响因子：
1.5
通讯作者：
Ohte N
中科院分区：
文献类型：
--
作者：
Goto T;Wakami K;Fukuta H;Fujita H;Tani T;Ohte N
根据我们先前的观察，收缩晚期主动脉血流的惯性应力(IS)常见于左心室射血分数(EF)相对较高的左心室。左心室射血分数相对较低的左心室多数不存在IS。因此，IS缺乏可能通过丢失LV弹性反冲与LV舒张期功能障碍相关，并可能参与心力衰竭(HF)的发病机制和存活率的降低。我们招募了144名连续接受心导管术的患者来诊断冠状动脉疾病。左心室造影测量左心室射血分数(LVEF)。根据LV压力(P)、−、dp/dt关系计算IS。这项回顾性结果观察性研究的研究终点结合了随后的急性失代偿性心力衰竭(ADHF)和全因死亡率。在随访期内(中位数6.1年)，观察到7人因ADHF意外住院，9人全因死亡。有IS的患者的无事件生存率显著高于无IS的患者(对数等级，p=0.001)。在多变量Cox回归分析中，在随访期间，缺乏IS是终点的主要预测因素(危险比：6.98；95%可信区间：1.48-33.03；P<0.01)。LVEF-≥(58%)是IS存在的替代指标，LVEF-≥(58%)患者的终点发生率低于LVEF(58%)患者。总而言之，缺乏IS或LVEF是未来ADHF和全因死亡率的预测指标。本文的在线版本(doi：10.1007/s00380015657-1)包含补充材料，可供授权用户使用。
Based on our previous observation, inertia stress (IS) of late systolic aortic flow was often observed in left ventricles with relatively higher left ventricular (LV) ejection fraction (EF). Most left ventricles with relatively lower LVEF did not have IS. Accordingly, lack of IS may correlate with LV diastolic dysfunction through the loss of LV elastic recoil and may contribute to the pathogenesis of heart failure (HF) and reduced survival. We enrolled 144 consecutive patients that underwent cardiac catheterization for the diagnosis of coronary artery disease. Left ventricular ejection fraction (LVEF) was obtained from left ventriculography. The IS was calculated from the LV pressure (P)−dP/dt relation. The study endpoint of this retrospective outcome-observational study was combined subsequent acute decompensated heart failure (ADHF) and all-cause mortality. During the follow-up period (median 6.1 years), seven unscheduled hospitalizations for ADHF and nine all-cause deaths were observed. The event-free survival rate was significantly higher among patients with IS than among patients without IS (log-rank, p = 0.001). On a multivariate Cox regression analysis, lack of IS was a prime predictor of the endpoint during follow-up (hazard ratio: 6.98; 95 % confidence interval: 1.48–33.03; p = 0.01). An LVEF ≥ 58 % was a surrogate indicator for the presence of IS, and patients with LVEF ≥ 58 % had fewer incidences of the endpoint than patients with LVEF < 58 %. In conclusion, lack of IS or LVEF < 58 % should be a predictor of future ADHF and all-cause mortality. The online version of this article (doi:10.1007/s00380-015-0657-1) contains supplementary material, which is available to authorized users.