AimsCompensatory 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 resultsWe 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.ConclusionsPupillometry 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.

中文翻译：

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瞳孔反射作为心力衰竭活动和预后的标志：一项纵向和前瞻性研究

目的触发心力衰竭 (HF) 的补偿机制以维持足够的心输出量。其中，交感神经系统（SNS）过度激活是主要原因之一，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它。本研究的目的是比较急性心力衰竭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且简单的预后因素。方法和结果我们前瞻性地连续纳入了 107 名患者因失代偿性心力衰竭入院。入院后 24 小时内和出院前使用 NeuroOptics 瞳孔测量仪进行定量瞳孔测量。结果与 100 名同样接受瞳孔测量的健康志愿者的结果进行了比较。测量最大基线瞳孔尺寸（MBPS）和最小瞳孔直径（MPD）。与出院时的心力衰竭患者和对照组相比，失代偿性心力衰竭患者的 MBPS (3.64 ± 0.81) 和 MPD (2.60 ± 0.58) 更高。磷‐值分别 = 0.01 和 0.01）。此外，心衰患者出院时瞳孔测量值有所改善 [MBPS (3.47 ± 0.79) 和 MPD (2.51 ± 0.58)]，与对照组 [MBPS (3.34 ± 0.82) 和 MPD (2.40 ± 0.53) 相比没有差异。 ](磷‐值分别 = 0.19 和 0.14）。此外，MBPS 为心衰患者的院内死亡率和 1 个月死亡率提供了良好的独立预测因子。入院期间死亡6例（5.61%），出院后第一个月死亡11例（10.2%）。此外，4 名患者（3.74%）在出院 1 个月内再次入院。通过 MBPS 预测院内死亡率的受试者工作特征 (ROC) 曲线为 0.823。 MBPS < 3.7 mm 的患者没有死亡。预测 MBPS 第一个月内综合死亡率或再入院的 ROC 曲线为 0.698。 结论 瞳孔测量可能是一种新的、非侵入性且简单的工具，用于确定 SNS 状态，有助于急性心力衰竭患者的预后分层，并改善治疗管理。