The 3A3B score: The simple risk score for heart failure with preserved ejection fraction - A report from the CHART-2 Study
The 3A3B score: The simple risk score for heart failure with preserved ejection fraction - A report from the CHART-2 Study
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DOI：
10.1016/j.ijcard.2018.10.076
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发表时间：
2019-06-01
影响因子：
3.5
通讯作者：
Shimokawa, Hiroaki
中科院分区：
文献类型：
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作者：
Kasahara, Shintaro;Sakata, Yasuhiko;Shimokawa, Hiroaki
背景资料：很少有简单的风险模型，没有超声心动图已经开发了心力衰竭（HF）和保留左心室射血分数（LVEF）（HFpEF）的患者。为了建立一个风险评分来预测HFpEF患者的全因死亡，我们在CHART-2研究中检查了1277名LVEF >= 50%和BNP >= 100 pg/ml的HF患者，日本一项针对HF的大规模前瞻性队列研究。我们用考克斯比例风险模型和随机生存森林（RSF.Results）为评分选择最佳协变量子集。考克斯模型和RSF分析一致表明年龄≥ 75岁、白蛋白≥ 1400 pg/ml和BUN ≥ 25 mg/dl是重要的6个预后变量。通过对这6个变量的分析，我们开发了一个评分系统（3A 3B评分，根据风险比，年龄≥ 75岁者得2分，其他年龄者得1分。风险评分的区分能力极好（c指数0.708）。关于模型拟合优度，评分很好地捕捉了5年风险的总体梯度。TOPCAT试验（N=835，c-index 0.652）和ASIAN-HF登记研究（N=170，c-index 0.741）的外部验证队列证实了3A 3B评分的预测准确性。结论：我们开发了一种简单的风险评分来预测HFpEF患者的长期预后。3A 3B评分包括6个日常实践中常用的参数，在HFpEF患者的风险分层和管理中具有潜在的实用性。(c)2018 Elsevier B. V.版权所有。
Background: Few simple risk models, without echocardiography have been developed for patients with heart failure (HF) and preserved left ventricular ejection fraction (LVEF) (HFpEF).Methods: To develop a risk score to predict all-cause death for HFpEF patients, we examined 1277 HF patients with LVEF >= 50% and BNP >= 100 pg/ml in the CHART-2 Study, a large-scale prospective cohort study for HF in Japan. We selected the optimal subset of covariates for the score with Cox proportional hazard models and random survival forests (RSF).Results: During the median 5.7-year follow-up, 576 deaths occurred. Cox models and RSF analyses consistently indicated age >= 75 years, albumin = 1400 pg/ml), and BUN >= 25 mg/dl, as the important 6 prognostic variables. Incorporating these 6 variables, we developed a scoring system (3A3B score, with 2 points given to age >= 75 years and 1 point to the others based on the hazard ratios. The discrimination ability of the risk score was excellent (c-index 0.708). Regarding model goodness-of-fit, the overall gradient in 5-year risk was well captured by the score. The predictive accuracy of the 3A3B score was confirmed in the external validation cohorts from the TOPCAT trial (N=835, c-index 0.652) and the ASIAN-HF registry (N=170, c-index 0.741).Conclusions: We developed a simple risk score to predict long-term prognosis of HFpEF patients. The 3A3B score, comprising 6 commonly available parameters in daily practice, has potential utility in the risk stratification and management of HFpEF patients. (c) 2018 Elsevier B.V. All rights reserved.