Incremental Prognostic Value of Conventional Echocardiography in Patients with Acutely Decompensated Heart Failure

Abstract Background: Acutely decompensated heart failure (ADHF) presents high morbidity and mortality in spite of therapeutic advance. Identifying factors of worst prognosis is important to improve assistance during the hospital phase and follow-up after discharge. The use of echocardiography for diagnosis and therapeutic guidance has been of great utility in clinical practice. However, it is not clear if it could also be useful for risk determination and classification in patients with ADHF and if it is capable of adding prognostic value to a clinical score (OPTIMIZE-HF). Objective: To identify the echocardiographic variables with independent prognostic value and to test their incremental value to a clinical score. Methods: Prospective cohort of patients consecutively admitted between January 2013 and January 2015, with diagnosis of acutely decompensated heart failure, followed up to 60 days after discharge. Inclusion criteria were raised plasma level of NT-proBNP (> 450 pg/ml for patients under 50 years of age or NT-proBNP > 900 pg/ml for patients over 50 years of age) and at least one of the signs and symptoms: dyspnea at rest, low cardiac output or signs of right-sided HF. The primary outcome was the composite of death and readmission for decompensated heart failure within 60 days. Results: Study participants included 110 individuals with average age of 68 ± 16 years, 55% male. The most frequent causes of decompensation (51%) were transgression of the diet and irregular use of medication. Reduced ejection fraction (研究背景：急性失代偿性心力衰竭（Acutely decompensated heart failure, ADHF）尽管治疗技术已有进步，但仍具有较高的发病率与死亡率。明确不良预后相关影响因素，对于优化住院阶段诊疗及出院后随访工作具有重要意义。超声心动图（echocardiography）在临床实践中已被广泛应用于疾病诊断与治疗指导，但目前尚不明确其是否可用于急性失代偿性心力衰竭患者的风险评估与分层，亦无法确定其能否为临床评分系统（OPTIMIZE-HF）增添预后预测价值。 研究目的：本研究旨在筛选具有独立预后价值的超声心动图变量，并检验其为临床评分系统带来的增量预后价值。 研究方法：本研究为前瞻性队列研究，纳入2013年1月至2015年1月期间连续收治的急性失代偿性心力衰竭患者，随访至出院后60天。纳入标准为血浆N末端B型利钠肽原（NT-proBNP）水平升高（50岁以下患者>450 pg/ml，50岁以上患者>900 pg/ml），且至少存在以下一项体征或症状：静息时呼吸困难、低心输出量或右侧心力衰竭体征。主要结局指标为出院后60天内因失代偿性心力衰竭死亡或再入院的复合终点。 研究结果：本研究共纳入110例受试者，平均年龄为68±16岁，男性占比55%。最常见的失代偿诱因（占比51%）为饮食不遵医嘱与药物服用不规律。射血分数降低（