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Abstract：
OBJECTIVE: 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.
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.
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.
摘要：
目的：心力衰竭（HF）的代偿机制被触发以维持足够的心输出量。其中,交感神经系统（SNS）的过度激活是主要的疾病之一，预后较差。瞳孔反射依赖于SNS,我们可以通过瞳孔测量来评估。该研究的目的是比较急性HF患者和对照组之间瞳孔反射的差异，并分析这些瞳孔反射的差异是否可以为此类患者提供新的简便预后因素。
结果：我们前瞻性和连续纳入了107例失代偿性HF患者。在入院后和出院前的第一个24小时内，使用NeuroOpics进行定量瞳孔测量。将结果与一组100名也进行了瞳孔测量的健康志愿者的结果进行了比较。测量最大基线瞳孔大小(MBPS)和最小瞳孔直径(MPD)。失代偿性HF患者出院时的MBPS（3.64±0.81）和MPD（2.60±0.58）高于HF患者和对照组（P值分别为0.01和0.01）。此外，HF患者出院时的瞳孔测量值[MBPS（3.47±0.79）和MPD（2.51±0.58）]有所改善，与对照组[MBPS（3.34±0.82）和MPD（2.40±0.53）]相比无差异（P值分别为0.19和0.14）。此外,MBPS为HF患者住院和1个月死亡率提供了良好的独立预测因子。6名患者(5.61%)在入院时死亡,出院后第一个月死亡11例(10.2%)。此外，4例患者(3.74%)在出院后1个月内再次入院.通过MBPS预测住院死亡率的受试者工作特征（ROC）曲线为0.823。MBPS<3.7mm的患者没有死亡。预测MBPS第一个月内合并死亡率或再入院的ROC曲线为0.698。
结论：瞳孔测量可能是一种新的，非侵入性，和简单的工具来确定SNS的状态，有助于急性HF患者的预后分层，改善治疗管理。
结果：我们前瞻性和连续纳入了107例失代偿性HF患者。在入院后和出院前的第一个24小时内，使用NeuroOpics进行定量瞳孔测量。将结果与一组100名也进行了瞳孔测量的健康志愿者的结果进行了比较。测量最大基线瞳孔大小(MBPS)和最小瞳孔直径(MPD)。失代偿性HF患者出院时的MBPS（3.64±0.81）和MPD（2.60±0.58）高于HF患者和对照组（P值分别为0.01和0.01）。此外，HF患者出院时的瞳孔测量值[MBPS（3.47±0.79）和MPD（2.51±0.58）]有所改善，与对照组[MBPS（3.34±0.82）和MPD（2.40±0.53）]相比无差异（P值分别为0.19和0.14）。此外,MBPS为HF患者住院和1个月死亡率提供了良好的独立预测因子。6名患者(5.61%)在入院时死亡,出院后第一个月死亡11例(10.2%)。此外，4例患者(3.74%)在出院后1个月内再次入院.通过MBPS预测住院死亡率的受试者工作特征（ROC）曲线为0.823。MBPS<3.7mm的患者没有死亡。预测MBPS第一个月内合并死亡率或再入院的ROC曲线为0.698。
结论：瞳孔测量可能是一种新的，非侵入性，和简单的工具来确定SNS的状态，有助于急性HF患者的预后分层，改善治疗管理。
