Acoustic Cardiography在心力衰竭患者危险分层及预后评估中的应用研究

Despite recent advances in its management, heart failure remains a major cause of disability and death and its prevalence is still increasing as the population ages. Risk stratification is helpful in triaging patients and guiding medical decision making, especially for the reduction in mortality and rehospitalization of heart failure patients. However, even with the development of current diagnostic and prognostic tools, the rapid risk stratification in patients with heart failure remains poorly defined. Acoustic cardiography (AUDICOR?, Inovise Medical, Inc., Portland, OR, USA) is an user friendly and cost-effective device which can be used in many clinical conditions. And it is also the unique technology which can evaluate the electrical and mechanical capabilities of the heart concurrently. The present study was designed to ascertain whether acoustic cardiography could facilitate risk stratification and provide prognostic value in patients with heart failure. All participants will undergo acoustic cardiographic, echocardiographic examination and BNP test on the same day. The adverse outcomes including all-cause mortality, cardiac death and rehospitalization for heart failure will be recorded during 1-year follow up. Our study will reveal whether acoustic cardiography could identify patients with heart failure at high risk for mortality who might benefit from aggressive monitoring and intervention. We will also further investigate the relationship of acoustic cardiography to echocardiography and BNP in cardiac function evaluation. This study may provide novel insights into the management of heart failure patients.

随着我国人口老龄化，心力衰竭（心衰）的发病率不断上升，且心衰患者的死亡率居高不下。心衰的危险分层和预后评估，对于指导治疗、降低死亡与再入院均有重要意义。虽然目前已有大量关于心衰患者危险分层及预后评估的方法，但是，迄今为止国内外尚未建立一种得到公认的简单易行的快速评估方法。Acoustic cardiography是一项简单实用的新技术，也是目前唯一可以同时评估心脏心电活动及机械运动功能的方法。本研究采用前瞻性设计，以心衰患者为研究对象，同时运用该技术联合超声心动图及BNP评价心功能，对患者进行为期1年的随访，记录不良终点事件，包括全因死亡、心因性死亡以及因心衰再次入院。本研究将揭示此项新技术在心衰危险分层及预后评估方面的潜在应用价值；并进一步挖掘该技术与超声心动图检查和BNP测定在心功能评价方面的关系，为心衰患者的管理提供新思路、新方法。

随着我国人口老龄化，心力衰竭的发病率不断上升，且心力衰竭患者的死亡率居高不下。心力衰竭的危险分层和预后评估，对于指导治疗、降低死亡与再入院均有重要意义。虽然目前已有大量关于心力衰竭患者危险分层及预后评估的方法，但是，迄今为止国内外尚未建立一种得到公认的简单易行的快速评估方法。Acoustic cardiography是一项简单实用的新技术，也是目前唯一可以同时评估心脏心电活动及机械运动功能的方法。. 本研究采用前瞻性设计，共募集474名心力衰竭患者，同时运用该技术联合超声心动图评价心功能，对患者进行随访，记录不良终点事件，包括全因死亡、心因性死亡。474名患者在随访期间（平均484天），共有169名患者死亡，其中126名患者死于心血管疾病。通过对比死亡与存活患者的基线资料，我们发现死亡患者的年龄更大，收缩压低，糖尿病的比例更高，血红蛋白以及白蛋白更低，肾功能更差，ACEI以及β受体阻滞剂的使用比例更低。矫正年龄、收缩压、血红蛋白、血尿素氮、白蛋白、以及血管紧张素转化酶抑制剂和beta受体阻滞剂的应用后，我们发现S3 score ≥ 4和SDI ≥ 5是全因死亡的独立预测因子。Kaplan-Meier分析显示SDI ≥ 5 or S3 score ≥ 4 的患者生存率更低 （52.2% vs. 69.2%, Log-rank χ2 = 18.07, P < 0.001; 56.8% vs. 68.6%, Log-rank χ2 = 10.58, P = 0.001）。. 本研究证实该项技术有助于心力衰竭患者的快速危险分层，从而识别出其中的高危患者，有助于医生的临床决策，最终改善患者的预后。该研究为心力衰竭患者的管理提供了新思路、新方法，尤其有助于基层医院心力衰竭患者管理的快速评估及转运。