A novel method to predict the proportional risk of sudden cardiac death in heart failure: Derivation of the Seattle Proportional Risk Model
A novel method to predict the proportional risk of sudden cardiac death in heart failure: Derivation of the Seattle Proportional Risk Model
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DOI：
10.1016/j.hrthm.2015.06.039
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发表时间：
2015-10-01
期刊：
影响因子：
5.5
通讯作者：
Levy, Wayne C.
中科院分区：
文献类型：
--
作者：
Shadman, Ramin;Poole, Jeanne E.;Levy, Wayne C.
背景：心力衰竭患者发生猝死和泵衰竭死亡的风险均增加。更好地识别那些从植入式心律转复除颤器（ICD）植入中获得最大净效益的患者的策略，可能会降低发病率并使ICD的成本效益最大化。
目的：我们旨在确定心肌病患者的基线变量，这些变量与猝死相对于非猝死所致死亡风险的不成比例部分独立相关。
方法：我们使用了9885例未植入ICD的心力衰竭患者的数据，其中2552例在平均2.3年的随访期间死亡。利用常见的基线临床和人口统计学变量，我们开发了一个多元回归模型来识别与猝死风险不成比例相关的变量。
结果：我们证实，较低的射血分数和较好的功能分级与猝死所致死亡比例较高相关。较年轻的年龄、男性、较高的体重指数与猝死的比例风险较高独立相关，而糖尿病、高/低血压、较高的肌酐水平和低钠血症与猝死的风险不成比例地较低相关。几种心力衰竭药物的使用、左心室舒张末期内径或N - 末端脑利钠肽前体浓度与猝死的不成比例风险无关。
结论：除射血分数和纽约心脏协会功能分级外，几个容易获得的基线人口统计学和临床变量与猝死风险不成比例地增加独立相关。需要进一步研究以评估这种新的预测方法是否可用于将挽救生命的治疗针对那些将获得最大死亡率益处的人群。
BACKGROUND Patients with heart failure are at increased risk of both sudden death and pump failure death. Strategies to better identify those who have greatest net benefit from implantable cardioverter-defibrillator (ICD) implantation could reduce morbidity and maximize cost-effectiveness of ICDs.OBJECTIVE We aimed to identify baseline variables in patients with cardiomyopathy that are independently associated with a disproportionate fraction of mortality risk attributable to sudden death vs nonsudden death.METHODS We used data from 9885 patients with heart failure without ICDs, of whom 2552 died during an average follow-up of 2.3 years. Using commonly available baseline clinical and demographic variables, we developed a multivariate regression model to identify variables associated with a disproportionate risk of sudden death.RESULTS We confirmed that lower ejection fraction and better functional class were associated with a greater proportion of mortality due to sudden death. Younger age, male sex, and higher body mass index were independently associated with a greater proportional risk of sudden death, while diabetes mellitus, hyper/hypotension, higher creatinine level, and hyponatremia were associated with a disproportionately Lower risk of sudden death. The use of several heart failure medications, Left ventricular end-diastolic dimension, or NT-pro brain natriuretic peptide concentrations were not associated with a disproportionate risk of sudden death.CONCLUSION Several easily obtained baseline demographic and clinical variables, beyond ejection fraction and New York Heart Association functional class, are independently associated with a disproportionately increased risk of sudden death. Further investigation is needed to assess whether this novel predictive method can be used to target the use of lifesaving therapies to populations who will derive greatest mortality benefit