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

Abstract

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.

Keywords

• Sol ventrikül disfonsiyonu
• kalp yetmezliği
• mortalite
• prognoz.

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

Abstract

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.

Keywords

• Left ventricular dysfunction
• heart failure
• mortality
• prognosis.

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