Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Am J Cardiol. 2010 May 15;105(10):1439-44. doi: 10.1016/j.amjcard.2009.12.067. Epub 2010 Mar 30.
The aim of the present study was to determine whether peak oxygen consumption (VO(2)) and the Heart Failure Survival Score (HFSS) predict prognosis in European-American, African-American, and Hispanic-American patients with chronic heart failure referred for heart transplantation. The peak VO(2) and the HFSS have previously been shown to effectively risk stratify patients with chronic heart failure and are criteria for the listing for heart transplantation. However, the effect of race on the predictive value of these variables has not been studied. A total of 715 patients with congestive heart failure (433 European American, 126 African American, 123 Hispanic American, and 33 other), who had been referred for heart transplantation, underwent cardiopulmonary exercise testing with measurement of the peak VO(2) and calculation of the HFSS. A total of 354 patients had died or undergone urgent heart transplantation or implantation of a left ventricular assist device during the 962 +/- 912 days of follow-up. On univariate and multivariate Cox hazard analysis, both peak VO(2) and the HFSS were powerful prognostic markers in the overall cohort and in the separate races. In the receiver operating characteristic curve analysis, the areas under the curve at 1 and 2 years of follow-up were greater for the HFSS than for peak VO(2). In conclusion, HFSS and peak VO(2) can be used for transplant selection; however, in the era of modern therapy and across races and genders, the HFSS might perform better than the peak VO(2).
本研究旨在确定最大摄氧量（VO2）和心力衰竭生存评分（HFSS）是否可以预测接受心脏移植的欧洲裔美国人、非裔美国人和西班牙裔美国人慢性心力衰竭患者的预后。先前已经证明，最大 VO2 和 HFSS 可以有效地对慢性心力衰竭患者进行风险分层，并且是进行心脏移植登记的标准。然而，种族对这些变量的预测价值的影响尚未得到研究。共有 715 名充血性心力衰竭（433 名欧洲裔美国人，126 名非裔美国人，123 名西班牙裔美国人，33 名其他）患者因心力衰竭接受了心脏移植，进行了心肺运动试验，测量了最大 VO2 并计算了 HFSS。在 962 ± 912 天的随访期间，共有 354 名患者死亡或接受了紧急心脏移植或左心室辅助装置植入。在单变量和多变量 Cox 危险分析中，最大 VO2 和 HFSS 都是整个队列和不同种族的强大预后标志物。在接收器操作特性曲线分析中，HFSS 的曲线下面积在 1 年和 2 年的随访中均大于最大 VO2。总之，HFSS 和最大 VO2 可用于移植选择；但是，在现代治疗时代以及跨越种族和性别的情况下，HFSS 的表现可能优于最大 VO2。
