心力衰竭生存评分持续预测接受β受体阻滞剂治疗的心力衰竭患者的临床结局。

Heart failure survival score continues to predict clinical outcomes in patients with heart failure receiving beta-blockers.

作者信息

Koelling Todd M, Joseph Susan, Aaronson Keith D

机构信息

Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, Michigan 48109, USA.

出版信息

J Heart Lung Transplant. 2004 Dec;23(12):1414-22. doi: 10.1016/j.healun.2003.10.002.

DOI:10.1016/j.healun.2003.10.002

PMID:15607672

Abstract

BACKGROUND

The Heart Failure Survival Score (HFSS) has been previously shown to effectively risk-stratify patients under evaluation for heart transplantation. However, this model was developed before broad use of beta blockade. We hypothesized that the prognostic tool would retain its ability to risk stratify patients treated with beta-blockers.

METHODS

We collected clinical data on 524 consecutive patients referred for heart transplantation from 1994 to 2001. Kaplan-Meier survival analysis and multivariable Cox regression analysis were performed with events defined as death, left ventricular assist device placement, or United Network of Organ Sharing 1 heart transplantation.

RESULTS

Kaplan-Meier analysis of the patient population revealed effective discrimination by the survival score both for beta-blocker treated and untreated patients (both p <0.0001). Two-year event-free survival was 94% +/- 2% and 84% +/- 4% for beta-blocker and no beta-blocker patients in the low-risk HFSS strata. Cox proportional hazard modeling showed that HFSS strata (medium risk: HR 2.65, 95% CI 1.75-4.02, p <0.001; high risk: HR 5.51, 95% CI 3.64-8.33, p <0.001) and beta-blocker treatment (HR 0.45, 95% CI 0.31-0.64, p <0.001) were significant predictors of event-free survival. Receiver operating curves (area under the curve) for HFSS strata used to predict 2-year events were similar for beta-blocker treated (0.78 +/- 0.04) and untreated (0.80 +/- 0.03) patients.

CONCLUSIONS

The HFSS provides effective risk stratification with or without beta-blocker therapy. Consideration of beta-blocker therapy with survival score strata improves outcome prediction in patients evaluated for heart transplantation.

摘要

背景

心力衰竭生存评分（HFSS）先前已被证明能有效地对接受心脏移植评估的患者进行风险分层。然而，该模型是在β受体阻滞剂广泛应用之前开发的。我们假设该预后工具在对接受β受体阻滞剂治疗的患者进行风险分层时仍能保持其能力。

方法

我们收集了1994年至2001年连续524例接受心脏移植评估患者的临床数据。采用Kaplan-Meier生存分析和多变量Cox回归分析，将事件定义为死亡、植入左心室辅助装置或器官共享联合网络1级心脏移植。

结果

对患者群体进行的Kaplan-Meier分析显示，生存评分对接受β受体阻滞剂治疗和未接受治疗的患者均有有效的区分能力（两者p<0.0001）。在低风险HFSS分层中，接受β受体阻滞剂治疗和未接受β受体阻滞剂治疗的患者两年无事件生存率分别为94%±2%和84%±4%。Cox比例风险模型显示，HFSS分层（中度风险：HR 2.65，95%CI 1.75 - 4.02，p<0.001；高度风险：HR 5.51，95%CI 3.64 - 8.33，p<0.001）和β受体阻滞剂治疗（HR 0.45，95%CI 0.31 - 0.64，p<0.001）是无事件生存的显著预测因素。用于预测两年事件的HFSS分层的受试者工作曲线（曲线下面积）在接受β受体阻滞剂治疗的患者（0.78±0.04）和未接受治疗的患者（0.80±0.03）中相似。