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Pupil reflex as a marker of activity and prognosis in heart failure: a longitudinal and prospective study.
Zamorano, Margarita; Monteagudo, Juan Manuel; González, Eduardo; Rayo, Isabel; Fernández, Sara; Castillo, Miguel; Zhou, Qiheng; de la Villa, Pedro; Zamorano, Jose Luis.
Afiliación
  • Zamorano M; Department of Ophthalmology, University Hospital of Guadalajara, Calle Donante de Sangre, Guadalajara, Spain.
  • Monteagudo JM; Department of Cardiology, Ramón y Cajal University Hospital, Madrid, Spain.
  • González E; Department of Cardiology, Ramón y Cajal University Hospital, Madrid, Spain.
  • Rayo I; Department of Cardiology, Ramón y Cajal University Hospital, Madrid, Spain.
  • Fernández S; Department of Cardiology, Ramón y Cajal University Hospital, Madrid, Spain.
  • Castillo M; Department of Cardiology, Ramón y Cajal University Hospital, Madrid, Spain.
  • Zhou Q; Department of Cardiology, Ramón y Cajal University Hospital, Madrid, Spain.
  • de la Villa P; Physiology Unit, Department of Systems Biology, School of Medicine, University of Alcalá, Madrid, Spain.
  • Zamorano JL; Visual Neurophysiology Group-IRYCIS, Madrid, Spain.
ESC Heart Fail ; 11(4): 1947-1954, 2024 Aug.
Article en En | MEDLINE | ID: mdl-38494834
ABSTRACT

AIMS:

Compensatory mechanisms in heart failure (HF) are triggered to maintain adequate cardiac output. Among them, hyperactivation of the sympathetic nervous system (SNS) is one of the main ones and carries a worse prognosis. The pupillary reflex depends on the SNS, and we can evaluate it through pupillometry. The aim of the study was to compare the differences in pupillary reflex between patients with acute HF and controls and to analyse whether these differences in pupillary reflex may offer a new and easy prognostic factor in such patients. METHODS AND

RESULTS:

We prospectively and consecutively included 107 patients admitted with decompensated HF. Quantitative pupillometry was performed with the NeuroOptics pupillometry during the first 24 h after admission and prior to discharge. The results were compared with those of a group of 100 healthy volunteers who also underwent pupillometry. The maximum baseline pupil size (MBPS) and the minimum pupil diameter (MPD) were measured. Patients with decompensated HF have a higher MBPS (3.64 ± 0.81) and higher MPD (2.60 ± 0.58) than HF patients at discharge and in the control group (P-value = 0.01 and 0.01, respectively). Also, HF patients presented an improvement in pupillometric values at discharge [MBPS (3.47 ± 0.79) and MPD (2.51 ± 0.58)] and showed no differences compared with the control group [MBPS (3.34 ± 0.82) and MPD (2.40 ± 0.53)] (P-value = 0.19 and 0.14, respectively). In addition, MBPS provides a good independent predictor of in-hospital and 1 month mortality in patients admitted with HF. Six patients (5.61%) died during hospital admission, and 11 patients (10.2%) died in the first month after discharge. Also, four patients (3.74%) were readmitted within 1 month of discharge. The receiver operating characteristic (ROC) curve for predicting in-hospital mortality through MBPS was 0.823. No patient with an MBPS < 3.7 mm died. The ROC curve for predicting combined mortality or readmission within the first month for MBPS was 0.698.

CONCLUSIONS:

Pupillometry may be a new, non-invasive, and simple tool to determine the status of SNS, help in the prognostic stratification of acute HF patients, and improve therapeutic management.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 6_ODS3_enfermedades_notrasmisibles Problema de salud: 6_cardiovascular_diseases / 6_other_circulatory_diseases Asunto principal: Reflejo Pupilar / Insuficiencia Cardíaca Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: ESC Heart Fail Año: 2024 Tipo del documento: Article País de afiliación: España

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 6_ODS3_enfermedades_notrasmisibles Problema de salud: 6_cardiovascular_diseases / 6_other_circulatory_diseases Asunto principal: Reflejo Pupilar / Insuficiencia Cardíaca Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: ESC Heart Fail Año: 2024 Tipo del documento: Article País de afiliación: España
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