{"title":"与后负荷相关的心脏性能是预测慢性心力衰竭患者死亡率的有力血液动力学指标。","authors":"Yihang Wu, Pengchao Tian, Lin Liang, Yuyi Chen, Jiayu Feng, Boping Huang, Liyan Huang, Xuemei Zhao, Jing Wang, Jingyuan Guan, Xinqing Li, Yuhui Zhang, Jian Zhang","doi":"10.1177/20406223231171554","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Afterload-related cardiac performance (ACP), a diagnostic parameter for septic cardiomyopathy, integrates both cardiac performance and vascular effects and could predict prognosis in septic shock.</p><p><strong>Objectives: </strong>We hypothesized that ACP would also correlate with clinical outcomes in patients with chronic heart failure (HF).</p><p><strong>Design: </strong>A retrospective study.</p><p><strong>Methods: </strong>We retrospectively studied consecutive patients with chronic HF who underwent right heart catheterization and established an expected cardiac output-systemic vascular resistance (CO-SVR) curve model in chronic HF for the first time. ACP was calculated as CO<sub>measured</sub>/CO<sub>predicted</sub> × 100%. ACP > 80%, 60% < ACP ⩽ 80%, and ACP ⩽ 60% represented less impaired, mildly impaired, and severely impaired cardiovascular function, respectively. The primary outcome was all-cause mortality, and the secondary outcome was event-free survival.</p><p><strong>Results: </strong>A total of 965 individual measurements from 290 eligible patients were used to establish the expected CO-SVR curve model (CO<sub>predicted</sub> = 53.468 × SVR <sup>-0.799</sup>). Patients with ACP ⩽ 60% had higher serum NT-proBNP levels (<i>P</i> < 0.001), lower left ventricular ejection fraction (<i>P</i> = 0.001), and required dopamine more frequently (<i>P</i> < 0.001). Complete follow-up data were available in 263 of 290 patients (90.7%). After multivariate adjustment, ACP remained associated with both primary outcome (hazard ratio (HR) 0.956, 95% confidence interval (CI) 0.927-0.987) and secondary outcome (HR 0.977, 95% CI 0.963-0.992). Patients with ACP ⩽ 60% had the worst prognosis (all <i>P</i> < 0.001). ACP was significantly more discriminating (area under the curve of 0.770) than other conventional hemodynamic parameters in predicting mortality (Delong test, all <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>ACP is a powerful independent hemodynamic predictor of mortality in patients with chronic HF. ACP and the novel CO-SVR two-dimensional graph could be useful in assessing cardiovascular function and making clinical decisions.</p><p><strong>Clinical trial registration: </strong>URL: https://www.clinicaltrials.gov. Unique identifier: NCT02664818.</p>","PeriodicalId":22960,"journal":{"name":"Therapeutic Advances in Chronic Disease","volume":"14 ","pages":"20406223231171554"},"PeriodicalIF":3.3000,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8c/3f/10.1177_20406223231171554.PMC10265365.pdf","citationCount":"0","resultStr":"{\"title\":\"Afterload-related cardiac performance is a powerful hemodynamic predictor of mortality in patients with chronic heart failure.\",\"authors\":\"Yihang Wu, Pengchao Tian, Lin Liang, Yuyi Chen, Jiayu Feng, Boping Huang, Liyan Huang, Xuemei Zhao, Jing Wang, Jingyuan Guan, Xinqing Li, Yuhui Zhang, Jian Zhang\",\"doi\":\"10.1177/20406223231171554\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Afterload-related cardiac performance (ACP), a diagnostic parameter for septic cardiomyopathy, integrates both cardiac performance and vascular effects and could predict prognosis in septic shock.</p><p><strong>Objectives: </strong>We hypothesized that ACP would also correlate with clinical outcomes in patients with chronic heart failure (HF).</p><p><strong>Design: </strong>A retrospective study.</p><p><strong>Methods: </strong>We retrospectively studied consecutive patients with chronic HF who underwent right heart catheterization and established an expected cardiac output-systemic vascular resistance (CO-SVR) curve model in chronic HF for the first time. ACP was calculated as CO<sub>measured</sub>/CO<sub>predicted</sub> × 100%. ACP > 80%, 60% < ACP ⩽ 80%, and ACP ⩽ 60% represented less impaired, mildly impaired, and severely impaired cardiovascular function, respectively. The primary outcome was all-cause mortality, and the secondary outcome was event-free survival.</p><p><strong>Results: </strong>A total of 965 individual measurements from 290 eligible patients were used to establish the expected CO-SVR curve model (CO<sub>predicted</sub> = 53.468 × SVR <sup>-0.799</sup>). Patients with ACP ⩽ 60% had higher serum NT-proBNP levels (<i>P</i> < 0.001), lower left ventricular ejection fraction (<i>P</i> = 0.001), and required dopamine more frequently (<i>P</i> < 0.001). Complete follow-up data were available in 263 of 290 patients (90.7%). After multivariate adjustment, ACP remained associated with both primary outcome (hazard ratio (HR) 0.956, 95% confidence interval (CI) 0.927-0.987) and secondary outcome (HR 0.977, 95% CI 0.963-0.992). Patients with ACP ⩽ 60% had the worst prognosis (all <i>P</i> < 0.001). ACP was significantly more discriminating (area under the curve of 0.770) than other conventional hemodynamic parameters in predicting mortality (Delong test, all <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>ACP is a powerful independent hemodynamic predictor of mortality in patients with chronic HF. ACP and the novel CO-SVR two-dimensional graph could be useful in assessing cardiovascular function and making clinical decisions.</p><p><strong>Clinical trial registration: </strong>URL: https://www.clinicaltrials.gov. 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Afterload-related cardiac performance is a powerful hemodynamic predictor of mortality in patients with chronic heart failure.
Background: Afterload-related cardiac performance (ACP), a diagnostic parameter for septic cardiomyopathy, integrates both cardiac performance and vascular effects and could predict prognosis in septic shock.
Objectives: We hypothesized that ACP would also correlate with clinical outcomes in patients with chronic heart failure (HF).
Design: A retrospective study.
Methods: We retrospectively studied consecutive patients with chronic HF who underwent right heart catheterization and established an expected cardiac output-systemic vascular resistance (CO-SVR) curve model in chronic HF for the first time. ACP was calculated as COmeasured/COpredicted × 100%. ACP > 80%, 60% < ACP ⩽ 80%, and ACP ⩽ 60% represented less impaired, mildly impaired, and severely impaired cardiovascular function, respectively. The primary outcome was all-cause mortality, and the secondary outcome was event-free survival.
Results: A total of 965 individual measurements from 290 eligible patients were used to establish the expected CO-SVR curve model (COpredicted = 53.468 × SVR -0.799). Patients with ACP ⩽ 60% had higher serum NT-proBNP levels (P < 0.001), lower left ventricular ejection fraction (P = 0.001), and required dopamine more frequently (P < 0.001). Complete follow-up data were available in 263 of 290 patients (90.7%). After multivariate adjustment, ACP remained associated with both primary outcome (hazard ratio (HR) 0.956, 95% confidence interval (CI) 0.927-0.987) and secondary outcome (HR 0.977, 95% CI 0.963-0.992). Patients with ACP ⩽ 60% had the worst prognosis (all P < 0.001). ACP was significantly more discriminating (area under the curve of 0.770) than other conventional hemodynamic parameters in predicting mortality (Delong test, all P < 0.05).
Conclusion: ACP is a powerful independent hemodynamic predictor of mortality in patients with chronic HF. ACP and the novel CO-SVR two-dimensional graph could be useful in assessing cardiovascular function and making clinical decisions.
期刊介绍：
Therapeutic Advances in Chronic Disease publishes the highest quality peer-reviewed research, reviews and scholarly comment in the drug treatment of all chronic diseases. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers involved in the medical treatment of chronic disease, providing a forum in print and online for publishing the highest quality articles in this area.
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