The size of a heart failure patient’s pupil can be a useful marker for prognosis, according to a new study.
Dr Kohei Nozaki of Kitasato University Hospital, Japan, and colleagues searched for ways to identify which patients are more likely to be readmitted to hospital.
They noted that the neuroendocrine dysregulation in heart failure is linked to raised sympathetic nervous system activation, which also controls the pupil’s response to light.
The team previously found that monitoring this response is useful to predict the prognosis in patients with heart failure, but measuring it can be difficult. Now they have found that a simple snapshot of the pupil can be a simpler and quicker marker of hospital readmission risk and mortality.
In ESC Heart Failure yesterday (11 August), they report on their study of 870 male and female patients hospitalised for acute heart failure in 2012 to 2017, with an average age of 67 years.
Patients’ pupil area was measured in both eyes at least a week after hospital admission, under standardised conditions, and they were put into two groups, for small or large pupil size.
Follow-up over nearly two years showed that patients in the small pupil area group had a significantly poorer survival rate and significantly higher rate of readmission for heart failure, compared to the large pupil area group.
This equated to a 28% lower risk of all-cause mortality and an 18% reduced risk of readmission due to heart failure in the small pupil area.
Dr Nozaki said: "Pupil area can be obtained rapidly, easily, and non-invasively. Patients with a small pupil area (e.g. less than 16.6 mm2) could be prioritised for cardiac rehabilitation with physical activity, which has been reported to improve autonomic function."
Nozaki, K. et al. Prognostic value of pupil area for all-cause mortality in patients with heart failure. ESC Heart Failure 11 August 2020; doi: 10.1002/ehf2.12933.
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