Pupil size may predict hospital readmission, death in acute HF
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Smaller pupil area measured in patients with acute HF was predictive of all-cause mortality and HF readmission, according to research published in ECS Heart Failure.
In addition, larger pupil size was associated with a more favorable prognosis, regardless of whether the patient was hospitalized with sinus rhythm (HR = 0.65; 95% CI, 0.48-0.88) or non-sinus rhythm HF (HR = 0.76; 95% CI, 0.57-1).
“Measurement of pupil area has good reproducibility and can be obtained rapidly, easily and noninvasively in routine clinical practice by pupillometry,” Kohei Nozaki, PT, MSc, of the department of rehabilitation at Kitasato University Hospital, Japan, and colleagues wrote. “The results of the present study suggested that pupil area could be used in nonsinus rhythm HF patients in whom autonomic function could not be assessed quantitatively using existing methods. Therefore, measurement of pupil area may be a useful alternative method to evaluate autonomic function in patients with HF, which is capable of providing additional prognostic information to conventional risk factors.”
For this retrospective study, investigators measured the pupils of 870 consecutive patients (mean age, 67 years; 37% women) hospitalized for acute HF using a pupilometer at least 7 days after hospital admission. Patients in the small pupil group had a measured area between 8.9 mm2 and 14.2 mm2 and the large pupil group was between 19.2 mm2 and 26 mm2.
Median follow-up was 1.9 years and the primary endpoint was allcause mortality and the secondary endpoint was readmission due to HF, according to the study.
“Pupil area measurement is a simple, noninvasive method that provides insight into the balance of both branches of the autonomic nervous system,” the researchers wrote. “Pupil area assessment has been used as a measure of autonomic function in a number of other conditions, including rheumatoid arthritis, Alzheimer’s disease, Parkinson’s disease, obstructive sleeping apnea and diabetes mellitus. However, none of these previous studies examined the correlation between pupil area and prognosis in patients with HF. To our knowledge, this is the first study to indicate an independent association between pupillary light reflex and allcause mortality in HF patients.”
Smaller pupils, greater risk
Researchers observed that patients with acute HF and small pupil area experienced greater frequency of CV death (61 with large pupil area vs. 29 with small pupil area; P < .001).
Survival was lower (P < .001) and the rate readmission for HF was higher among patients with smaller pupil area compared with patients with a larger area (P < .001).
Even after adjusting for other prognostic factors, including the Seattle HF score, smaller pupil area was an independent predictor of allcause mortality (HR = 0.72; 95% CI, 0.59-0.88) and hospital readmission for HF (HR = 0.82; 95% CI, 0.73-0.93), according to the study.
Underlying mechanism still undetermined
“Typical autonomic nervous dysregulation in HF involves sympathetic activation or parasympathetic suppression, in which the pupil is dilated, thus increasing its area,” the researchers wrote. “However, the results of the present study suggested that small pupil area was associated with poor prognosis in patients with HF. Although the mechanism underlying this association has yet to be determined, we postulated that it may be similar to the mechanism of chronotropic incompetence.”
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