Prognostic Stratification of Clinically Stable Patients with Heart Failure by Echocardiographic Pressure/Volume Loop Model
Copyright © 2023 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Pressure/volume (P/V) loops provide useful information on left ventricular performance and prognosis in patients with heart failure (HF) but do not lend themselves to routine clinical practice. The authors developed a noninvasive method to compute individualized P/V loops to predict adverse clinical outcomes in patients with stable HF, which the authors believe can be used clinically.
METHODS: A derivation cohort (n = 443 patients) was used to develop an echocardiography P/V loop model, using brachial arterial pressure and trans-thoracic two-dimensional Doppler echocardiographic data. Each patient's P/V loop was depicted as an irregular pentagon, and a centroid was derived for each loop. The centroid distance (CD) from a reference centroid (derived from 101 healthy control subjects) was computed. This model was prospectively applied to 435 patients who constituted the validation cohort. The study end point was a composite of cardiac death or hospitalization for HF among study patients.
RESULTS: In the derivation cohort, CD was threefold greater among patients who experienced adverse events than those who did not. During a follow-up period of 30 months (15-45 months), event rates were 35% (72 of 206 patients) and 12% (29 of 237 patients P < .001), respectively, among patients with CD > 33 mL/mm Hg and those with CD ≤33 mL/mm Hg (prognostic cutoff derived by receiver operating characteristic analysis). Multivariate Cox analysis identified CD as an independent predictor of adverse outcome (hazard ratio, 1.61; 95% CI, 1.03-2.50) independently of left ventricular end-diastolic volume, pulmonary capillary wedge pressure, and left ventricular ejection fraction. These conclusions were confirmed in the validation cohort.
CONCLUSIONS: The authors propose a method to create a noninvasive P/V loop and its centroid. These data provide useful pathophysiologic and prognostic information in patients with HF.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:36 |
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| Enthalten in: |
Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography - 36(2023), 7 vom: 01. Juli, Seite 746-759 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Cioffi, Giovanni [VerfasserIn] |
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| Links: |
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| Themen: |
Echocardiography |
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| Anmerkungen: |
Date Completed 10.07.2023 Date Revised 15.04.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.echo.2023.02.006 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM352983671 |
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| 100 | 1 | |a Cioffi, Giovanni |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Prognostic Stratification of Clinically Stable Patients with Heart Failure by Echocardiographic Pressure/Volume Loop Model |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Pressure/volume (P/V) loops provide useful information on left ventricular performance and prognosis in patients with heart failure (HF) but do not lend themselves to routine clinical practice. The authors developed a noninvasive method to compute individualized P/V loops to predict adverse clinical outcomes in patients with stable HF, which the authors believe can be used clinically | ||
| 520 | |a METHODS: A derivation cohort (n = 443 patients) was used to develop an echocardiography P/V loop model, using brachial arterial pressure and trans-thoracic two-dimensional Doppler echocardiographic data. Each patient's P/V loop was depicted as an irregular pentagon, and a centroid was derived for each loop. The centroid distance (CD) from a reference centroid (derived from 101 healthy control subjects) was computed. This model was prospectively applied to 435 patients who constituted the validation cohort. The study end point was a composite of cardiac death or hospitalization for HF among study patients | ||
| 520 | |a RESULTS: In the derivation cohort, CD was threefold greater among patients who experienced adverse events than those who did not. During a follow-up period of 30 months (15-45 months), event rates were 35% (72 of 206 patients) and 12% (29 of 237 patients P < .001), respectively, among patients with CD > 33 mL/mm Hg and those with CD ≤33 mL/mm Hg (prognostic cutoff derived by receiver operating characteristic analysis). Multivariate Cox analysis identified CD as an independent predictor of adverse outcome (hazard ratio, 1.61; 95% CI, 1.03-2.50) independently of left ventricular end-diastolic volume, pulmonary capillary wedge pressure, and left ventricular ejection fraction. These conclusions were confirmed in the validation cohort | ||
| 520 | |a CONCLUSIONS: The authors propose a method to create a noninvasive P/V loop and its centroid. These data provide useful pathophysiologic and prognostic information in patients with HF | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Echocardiography | |
| 650 | 4 | |a Heart failure | |
| 650 | 4 | |a Left ventricular performance | |
| 650 | 4 | |a Pressure/volume loop | |
| 650 | 4 | |a Prognosis | |
| 700 | 1 | |a Battiston, Roberto |e verfasserin |4 aut | |
| 700 | 1 | |a Mancusi, Costantino |e verfasserin |4 aut | |
| 700 | 1 | |a Di Lenarda, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Faganello, Giorgio |e verfasserin |4 aut | |
| 700 | 1 | |a Aurigemma, Gerard P |e verfasserin |4 aut | |
| 700 | 1 | |a Tarantini, Luigi |e verfasserin |4 aut | |
| 700 | 1 | |a Pulignano, Giovanni |e verfasserin |4 aut | |
| 700 | 1 | |a Cioffi, Viola |e verfasserin |4 aut | |
| 700 | 1 | |a de Simone, Giovanni |e verfasserin |4 aut | |
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