Background

Although routine echocardiographic parameters such as ejection fraction are used to risk-stratify for death in patients referred for echocardiography, they have limited predictive value. The authors speculated that noninvasive hemodynamic echocardiographic data, assessing left ventricular filling pressure and output, stratified on the basis of the clinical Killip score, might have additive prognostic value on top of routine echocardiographic parameters. The authors created an echocardiographic correlate of this classification, using diastolic grade and stroke volume index (SVI) as indicators of pulmonary congestion and systemic perfusion, respectively, and evaluated the prognostic value of this correlate.

Methods

A retrospective study of consecutive patients (hospitalized or not) referred for echocardiography for a range of cardiac diagnoses in a tertiary medical center. A total of 556 patients in sinus rhythm who were evaluated by two sonographers, and reviewed by a single cardiologist, were included. Normal filling pressure and normal SVI (>35 mL/m²) defined echocardiographic Killip (eKillip) class 1. Patients with pseudonormal or restrictive diastolic patterns and normal SVI were ascribed to eKillip class 2 or 3, respectively. A pseudonormal or restrictive diastolic pattern and a subnormal SVI defined eKillip class 4.

Results

eKillip class 1 was present in 382 patients (68%); 115 (20%), 26 (5%), and 42 (7%) patients were in eKillip classes 2 to 4, respectively. Median follow-up time was 1,056 days (interquartile range, 729-1,390 days). A total of 105 deaths occurred. Univariate Cox regression analysis showed that eKillip class was associated with all-cause mortality; hazard ratios (HR) −2.73 (95% CI, 1.67-4.48), 3.19 (95% CI, 1.42-7.17), and 4.79 (95% CI, 2.58-8.89) for each eKillip class above 1 (P < .001). In a multivariate analysis adjusted for the Charlson comorbidity index, eKillip class remained independently associated with all-cause mortality (P = .04).

Conclusions

eKillip class was associated with all-cause mortality among all patients undergoing echocardiography at a tertiary hospital.

中文翻译：

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超声心动图 Killip 分类

背景

尽管常规超声心动图参数（如射血分数）用于对转诊进行超声心动图检查的患者进行死亡风险分层，但它们的预测价值有限。作者推测，基于临床 Killip 评分分层的评估左心室充盈压和输出的无创血流动力学超声心动图数据可能在常规超声心动图参数之上具有附加的预后价值。作者创建了该分类的超声心动图相关性，分别使用舒张期和每搏输出量指数 (SVI) 作为肺充血和全身灌注的指标，并评估了该相关性的预后价值。

方法

一项对连续患者（住院或未住院）的回顾性研究，这些患者在三级医疗中心接受超声心动图检查以进行一系列心脏诊断。共有 556 名窦性心律患者由两名超声医师评估，并由一名心脏病专家进行审查。正常充盈压力和正常 SVI (>35 mL/m ² ) 定义超声心动图 Killip (eKillip) 1 级。具有假正常或限制性舒张模式和正常 SVI 的患者分别归于 eKillip 2 级或 3 级。伪正常或限制性舒张模式和低于正常的 SVI 定义了 eKillip 4 级。

结果

382 名患者 (68%) 存在 eKillip 1 类；分别有 115 名 (20%)、26 名 (5%) 和 42 名 (7%) 患者处于 eKillip 2 至 4 级。中位随访时间为 1,056 天（四分位距，729-1,390 天）。共有105人死亡。单变量 Cox 回归分析显示 eKillip 等级与全因死亡率相关；风险比 (HR) -2.73 (95% CI, 1.67-4.48), 3.19 (95% CI, 1.42-7.17) 和 4.79 (95% CI, 2.58-8.89) 对于每个高于 1 的 eKillip 类别 ( P  < .001 ）。在针对 Charlson 合并症指数进行调整的多变量分析中，eKillip 等级仍然与全因死亡率独立相关（P  = .04）。

结论

在三级医院接受超声心动图检查的所有患者中，eKillip 等级与全因死亡率相关。