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Published on: June 10, 2025
Prognostic value of pupil area for all-cause mortality in patients with heart failure
Kohei Nozaki1, Nobuaki Hamazaki1, Shohei Yamamoto2,3
1Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
Insights
Pupil size is a new prognostic indicator for heart failure (HF) patients. Larger pupil area predicts better outcomes, reducing mortality and hospital readmissions for HF.
Area of Science:
- Cardiology
- Autonomic Function
- Ophthalmology
Background:
- Pupil size reflects autonomic nervous system activity.
- Prognostic value of pupil area in heart failure (HF) is not well-established.
Purpose of the Study:
- To investigate pupil area as a prognostic indicator in patients with HF.
- To determine if pupil area improves risk prediction models for HF outcomes.
Main Methods:
- Retrospective review of 870 acute HF patients.
- Pupil area measured via pupilometer post-hospitalization.
- Primary endpoint: all-cause mortality; Secondary endpoint: HF readmission.
Main Results:
- Pupil area independently predicted mortality (HR 0.72) and HF readmission (HR 0.82).
- Increased pupil area was associated with better prognosis.
- Adding pupil area to the Seattle Heart Failure Score (SHFS) improved mortality prediction.
Conclusions:
- Pupil area is an independent predictor of mortality and readmission in HF patients.
- Pupil area provides additional prognostic value beyond existing scores like SHFS.
- Pupil area shows potential as a novel prognostic marker for HF.
Aims:
The area of the pupil can be used as an indicator of autonomic function. However, the relation between pupil area and prognosis in heart failure (HF) patients remains unclear. This study was performed to examine whether pupil area can be used as a prognostic indicator in patients with HF.
Methods And Results:
This retrospective review was performed in 870 consecutive patients (mean age: 67.0 ± 14.1 years, 37.0% women) hospitalized for acute HF. Pupil area was measured with a pupilometer at least 7 days after hospitalization for HF. The primary endpoint was all-cause mortality, and the secondary endpoint was readmission due to HF. A total of 131 patients died, and 328 patients were readmitted because of HF over a median follow-up of 1.9 (interquartile range: 1.0-3.7 years) years. After adjustment for several pre-existing prognostic factors, including Seattle Heart Failure Score (SHFS), pupil area was shown to be independently associated with all-cause mortality (hazard ratio: 0.72; 95% confidence interval: 0.59-0.88; P = 0.001) and readmission due to HF (hazard ratio: 0.82; 95% confidence interval: 0.73-0.93; P = 0.003). Addition of pupil area to SHFS significantly increased the area under the receiver-operating characteristic curve for all-cause mortality (0.69 vs. 0.72, respectively; P = 0.034).
Conclusions:
Pupil area is an independent predictor of all-cause mortality and readmission due to HF and adds prognostic information to SHFS in patients with HF. The results presented here suggest that pupil area may be useful as a prognostic marker in patients with HF.
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