İleri evre kalp yetmezliği olan hastalarda sol ventriküler atım iş indeksinin prognostik değeri

Yıl 2022, Cilt: 13 Sayı: 1, 9 - 15, 26.03.2022

Ömer Yıldız Cemal Yenigün

https://doi.org/10.18663/tjcl.981827

Öz

Amaç: Azalan miyokard kontraktilitesinin ileri evre kalp yetmezliği (KY) olan hastaların sonuçları üzerindeki etkisi ve ölçümü için doğru ölçüm birimi çok önemlidir. Bu çalışma, ileri evre KY olan hastalarda miyokard kontraktilitesinin bir ölçüsü olarak kabul edilen sol ventrikül atım iş indeksinin (LVSWI) prognostik değerini araştırmayı amaçlamaktadır.
Gereç ve Yöntemler: Eylül 2010 ile Temmuz 2013 tarihleri arasında spesifik tedavi yöntemlerini alabilmek için hastaneye başvuran ileri evre KY olan 172 hasta bu çalışmaya dahil edildi. Başlangıçta kardiyak kateter bazlı elde edilen hemodinamik ölçümler longitudinal takipte (median 52 ay) ortaya çıkan olumsuz sonuçlar (kardiyak mortalite, ventriküler destek cihazı (VAD) implantasyonu ve kalp nakli (HTx)) ile değerlendirildi.
Bulgular: Median LVSWI 16 cJ/m2 idi. Azalan LVSWI (<16 cJ/m2), artan olumsuz sonuçlarla ilişkilendirildi. 50 kardiyak ölüm, 12 VAD implantasyonu ve 10 HTx gözlemledik. LVSWI'nin prognostik değeri, yaş, cinsiyet, ortalama arter basıncı, pulmoner vasküler direnç, sağ atriyal basınç ve tahmini glomerüler filtrasyon hızı için düzeltmeler yapıldıktan sonra anlamlı kaldı (HR 0.379, %95 CI 0.17-0.84, p=0.017).
Sonuç: Azalmış LVSWI, ileri evre KY hastalarında olumsuz sonuçların bağımsız bir öngörücüsüdür. Bu nedenle, klinik sonuçları tahmin etmek için bu hastalarda bireysel risk sınıflandırması için kullanılabilir.

Anahtar Kelimeler

Sol ventrikül disfonsiyonu, kalp yetmezliği, mortalite, prognoz.

Prognostic value of left ventricular stroke work index in patients with advanced heart failure

Öz

Aim: The impact of reduced myocardial contractility on patients’ outcomes with advanced heart failure (HF) and the correct measurement units for its measure is most important. The present work aims to evaluate the prognostic value of the left ventricular stroke work index (LVSWI), which is considered a measure of myocardial contractility, in patients with advanced HF.
Material and Methods: Between September 2010 and July 2013, 172 patients with advanced HF admitted to the hospital to guide the specified therapies were included in this study. At baseline, patients were assessed with cardiac catheter-based hemodynamic measurements, ensued by the longitudinal follow-up (median of 52 months) for adverse outcomes (cardiac mortality, ventricular assist device (VAD) placement, and heart transplant (HTx)).
Results: Median LVSWI was 16 cJ/m2. Decreased LVSWI (<16 cJ/m2) was associated with increased adverse outcomes. We observed 50 cardiac deaths, 12 VAD placements and 10 HTx. The prognostic value of LVSWI remained significant after adjustment for age, gender, mean arterial pressure, pulmonary vascular resistance, right atrial pressure and estimated glomerular filtration rate (HR 0.379, 95% CI 0.17-0.84, p=0.017).
Conclusion: Lower LVSWI is an independent predictor of adverse outcomes in patients with advanced HF. Therefore, it could be used for individual risk stratification in these patients to predict clinical outcomes.

Anahtar Kelimeler

Left ventricular dysfunction, heart failure, mortality, prognosis.

Kaynakça

• 1. Ramsey JD, Tisdale LA. Use of ventricular stroke work index and ventricular function curves in assessing myocardial contractility. Crit Care Nurse 1995; 15: 61-7.
• 2. Bilchick KC, Mejia-Lopez E, McCullough P, et al. Clinical impact of changes in hemodynamic indices of contractile function during treatment of acute decompensated heart failure. J Card Fail 2018; 24: 43-50.
• 3. Cooper LB, Mentz RJ, Stevens SR, et al. Hemodynamic Predictors of Heart Failure Morbidity and Mortality: Fluid or Flow? J Card Fail 2016; 22: 182-9.
• 4. Schramm W. The units of measurement of the ventricular stroke work: a review study. J Clin Monit Comput 2010; 24: 213-7.
• 5. American Heart Association. AHA medical/scientific statement 1994 revisions to classification of functional capacity and objective assessment of patients with disease of the heart. Circulation 1994; 90: 644-5.
• 6. Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 2013; 26: 921-64.
• 7. Thompson S, James M, Wiebe N, , et al. Cause of Death in Patients with Reduced Kidney Function. J Am Soc Nephrol 2015; 26: 2504-11.
• 8. Yildiz O, Aslan G, Demirozu ZT, et al. Evaluation of Resting Cardiac Power Output as a Prognostic Factor in Patients with Advanced Heart Failure. Am J Cardiol 2017; 120: 973-9.
• 9. Pilz G, Appel R, McGinn P. Calculation of the left ventricular stroke work index. Crit Care Med 1993; 21: 1248.
• 10. Settergren G. The calculation of left ventricular stroke work index. Acta Anaesthesiol Scand 1986; 30: 450-2.
• 11. Tan LB. Cardiac pumping capability and prognosis in heart failure. Lancet 986; 2: 1360-3.
• 12. Leung DY, Armstrong G, Griffin BP, et al. Latent left ventricular dysfunction in patients with mitral regurgitation: feasibility of measuring diminished contractile reserve from a simplified model of noninvasively derived left ventricular pressure-volume loops. Am Heart J 1999; 137: 427-34.
• 13. La Vecchia L, Varotto L, Spadaro GL, et al. Left ventricular stroke work reserve as prognostic marker in severe heart failure. Minerva Cardioangiol 2006; 54: 249-55.
• 14. Ronco C, McCullough P, Anker SD, et al. Acute Dialysis Quality Initiative (ADQI) consensus group. Cardio-renal syndrome: report from consensus conference of the acute dialysis qualitative initiative. Eur Heart J 2010; 31: 703-11.
• 15. Dimopoulus K, Diller GP, Koltsida E, et al. Prevalence, predictors, and prognostic value of renal dysfunction in adults with congenital heart disease. Circulation 2008; 117: 2320-8.
• 16. Rao S, Tate DA, Stouffer GA. Hemodynamic findings in severe tricuspid regurgitation.Catheter Cardiovasc Interv 2013; 81: 162-9.
• 17. Domanski MJ, Mitchell GF, Norman JE, et al. Independent prognostic information provided by sphygmomanometrically determined pulse pressure and mean arterial pressure in patients with left ventricular dysfunction. JACC 1999; 33: 951-58.
• 18. Simmons J, Ventetuolo CE. Cardiopulmonary monitoring of shock. Curr Opin Crit Care 2017; 23: 223-31.
• 19. Franciosa JA. Why patients with heart failure die: hemodynamic and functional determinants of survival. Circulation 1987; 75: 20-7.
• 20. Szabo B, Marosi EK, Vargova K, et al. Cardiac Index by Transthoracic Echocardiography (CITE) study. PLoS One 2018; 13: 0207269.
• 21. Ochagavia A, Zapata L, Carrillo A, et al. Evaluation of contractility and postloading in the intensive care unit. Med Intensiva 2012; 36: 365-74.