Abstract
Objective This prospective study aimed to evaluate the value of the cardiac cycle time-corrected electromechanical activation time (EMATc) measured at admission for predicting major cardiac adverse events (MACEs) in hospitalized patients with chronic heart failure (CHF). Methods CHF patients with a left ventricular ejection fraction (LVEF) lower than 50% (N = 145) were enrolled in this study. Documented clinical end-points (MACEs) included cardiogenic death, onset of acute HF as assessed with invasive and noninvasive mechanical ventilation, and cardiogenic shock. According to the different clinical end-points, patients were divided into two groups: a MACE group (n = 22) and a nonMACE group (n = 123). EMATc, LVEF, and circulating levels of B type natriuretic peptide (BNP) and Troponin I (TnI) were measured. Multivariate logistic regression analysis was used to examine the association between EMATc and MACEs. The parameters adjusted in the multivariable model included EMATc, BNP, and heart rate. The predictive value of EMATc was evaluated by receiver operating characteristic (ROC) curve analysis. Results Elevated EMATc was an independent risk factor for MACEs (odds ratio [OR] 1.1443, 95% confidence interval [CI] 1.016–1.286, P = 0.027). The area under the ROC curve for EMATc was 0.799 (95% CI 0.702–0.896, P < 0.001). The optimal cutoff EMATc value was >13.8% with a sensitivity of 81.8% and a specificity of 65.9%. Conclusions We demonstrated that an elevated EMATc measured at admission is an independent risk factor for MACEs among hospitalized CHF patients. Acoustic cardiography measured at admission may provide a simple, noninvasive method for risk stratification of CHF patients. This trial is registered with ChiCTR1900021470.
Highlights
Advances in the diagnostic technologies and treatment of heart disease have been made over the past decade, the readmission and mortality rates among chronic heart failure (CHF) patients remain high
Echocardiography is a valuable tool for CHF diagnosis, as it noninvasively measures the structure of the heart chambers and the le ventricular ejection fraction (LVEF), and it is well-recognized that a decrease in the LVEF is associated with the severity of HF as well as a decrease in the survival rate [5]
A total of 145 patients (106 males, 73.1%) with an average age of 57.9 ± 15.3 years were enrolled in this prospective study. ese patients were divided into two groups according the different outcomes. e mean in-hospital duration was 7.50 (3.75, 10.25) days. e major adverse cardiac events (MACEs) group had 22 patients with MACEs, of whom 12 (54.5%) had exacerbation of acute le HF, 9 (40.9%) had cardiogenic death, and 1 had cardiogenic shock (4.5%). e nonMACE group two had 123 patients who did not experience any MACEs. ere were no statistically significant differences with regard to age, gender, or prior medical history including hypertension, diabetes, myocardial infarction, percutaneous coronary intervention, coronary artery bypass gra ing, or chronic renal insufficiency between the two groups (Table 1)
Summary
Advances in the diagnostic technologies and treatment of heart disease have been made over the past decade, the readmission and mortality rates among chronic heart failure (CHF) patients remain high. The all-cause mortality of CHF patients was 17%, and the readmission rate within 12 months was 44% [1]. A more complete understanding of the risk factors for the occurrence of major adverse cardiac events (MACEs) associated with CHF is urgently needed [2]. A method for early assessment of the risk of developing MACEs as well as an early warning can significantly reduce both the mortality and medical cost associated with CHF [3, 4]. Erefore, other indexes, such as blood levels of B type natriuretic peptide (BNP), have been introduced. The plasma BNP level is a ected by many factors, including atrial brillation, age, renal insu ciency, and body mass index (BMI) [8,9,10]. erefore, the blood BNP level has limitations in its utility for HF prognosis. us, Cardiovascular erapeutics identification of novel parameters that are specific and convenient for predicting MACEs in CHF patients is needed, so that appropriate treatments can be initiated as early as possible
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