Validation of peak exercise oxygen consumption and the Heart Failure Survival Score for serial risk stratification in advanced heart failure
Validation of peak exercise oxygen consumption and the Heart Failure Survival Score for serial risk stratification in advanced heart failure
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DOI：
10.1016/j.amjcard.2004.11.024
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发表时间：
2005-03-15
影响因子：
2.8
通讯作者：
Mancini, DM
中科院分区：
文献类型：
--
作者：
Lund, LH;Aaronson, KD;Mancini, DM
心力衰竭生存评分（HFSS）和峰值运动耗氧量（VO 2）可准确评估晚期心力衰竭患者的死亡率，并进行初次心脏移植评估。我们研究了HFSS和峰值VO 2对这些患者的预后价值。该研究包括227名成人（平均年龄+/- SID 52 +/- 10岁），他们在初始评估后> 60天（352 +/- 238天）进行重新评估。根据平均动脉压、心率、左室射血分数、血钠、峰值VO 2、心力衰竭病因和QRS波群宽度确定HFSS。采用Kaplan-Meier法确定无再评估、United Network of Organ Sharing I移植或左心室辅助装置的生存率，并在United Network of Organ Sharing 2移植时删失。HFSS分层（p < 0.001）和VO 2峰值分层（p < 0.001）的生存率不同。HFSS或峰值VO 2从低危恶化为中危或高危的患者，其生存率低于仍处于低危的患者（分别为p < 0.01和p < 0.001）开始时处于中或高风险并改善为低风险的患者往往比那些仍然处于中或高风险的患者有更高的生存率。（分别为p = 0.06和p < 0.16）。HFSS和峰值VO 2改善至低风险的患者1年生存率为72%。然而，改善至低风险并接受6种阻滞剂治疗的患者的1年生存率（HFSS为89%，峰值VO 2为83%）与移植后的1年生存率（84%）相当。峰值VO 2和HFSS可成功用于晚期心力衰竭非卧床患者死亡风险的系列评估。(c)2005年，Excerpta Medica Inc.
The Heart Failure Survival Score (HFSS) and peak exercise oxygen consumption (VO2) accurately assess mortality in ambulatory patients who have advanced heart failure and are referred for initial cardiac transplant evaluation. We investigated the prognostic value of the HFSS and peak VO2 when applied serially to these patients. This study included 227 adults (mean age +/- SID 52 +/- 10 years old) who presented for reevaluation > 60 days after initial evaluation (352 +/- 238 days). The HFSS was determined from mean arterial blood pressure, heart rate, left ventricular ejection fraction, serum sodium, peak VO2, heart failure etiology, and width of QRS complex. Survival without reevaluation, United Network of Organ Sharing I transplant, or left ventricular assist device was determined by the Kaplan-Meier method with censoring at United Network of Organ Sharing 2 transplant. Survival differed by HFSS stratum (p < 0.001) and by peak VO2 stratum (p < 0.001). Patients whose HFSS or peak VO2 deteriorated from low risk to medium or high risk had lower survival rates than did patients whose values remained at low risk (p < 0.01 and p < 0.001, respectively) Patients who started at medium or high risk and improved to low risk tended to have higher survival rates than those who remained medium or high risk (p = 0.06 and p < 0.16, respectively). Patients who improved to low risk had a 1-year survival rate of 72% for HFSS and peak VO2. However, patients who improved to low risk and were treated with 6 blockers had a 1-year survival rate (89% for HFSS and 83% for peak VO2) comparable to that after transplant (84%). Peak VO2 and the HFSS can be successfully used for serial evaluction of mortality risk in ambulatory patients who have advanced heart failure. (c) 2005 by Excerpta Medica Inc.