Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
J Heart Lung Transplant. 2011 Mar;30(3):315-25. doi: 10.1016/j.healun.2010.09.007. Epub 2010 Nov 18.
The peak oxygen consumption (VO(2)) and the Heart Failure Survival Score (HFSS) risk stratify patients with chronic heart failure (CHF) referred for heart transplantation. However, these tools were developed before widespread use of implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT). The prognostic accuracy of these tools in patients with ICD and/or CRT is unknown.
Cardiopulmonary exercise testing with measurement of peak VO(2) and calculation of the HFSS was done in 715 CHF patients (54 ± 12 years; ICD, 244; CRT, 30; CRT-D, 108; none, 333) referred for heart transplantation.
During an average follow-up of 962 ± 912 days, 354 patients died or received urgent heart transplant or left ventricular assist device. By Cox hazard analysis, both peak VO(2) and HFSS were powerful independent prognostic markers. By Kaplan-Meier analysis, the HFSS was effective in discriminating patients into low-, medium-, and high-risk groups in all device groups. In contrast, the peak VO(2) did not discriminate between low (>14 ml/min/kg) and medium (10.1 to 14 ml/min/kg) risk in device patients. By area under the receiver operating characteristic curve, the HFSS performed better than the peak VO(2) (1-year in total cohort; 0.72 vs. 0.65; p < 0.001; 1-year in device patients; 0.69 vs. 0.65; p < 0.001).
The HFSS outperforms the peak VO(2) in risk stratification for CHF in the presence of an ICD and/or CRT. Furthermore, a peak VO(2) ≤ 10 ml/kg/min rather than the traditional cutoff value ≤ 14 ml/min/kg may be more useful for risk stratification in the device era.
最大摄氧量（VO₂）和心力衰竭生存评分（HFSS）可对接受心脏移植的慢性心力衰竭（CHF）患者进行风险分层。然而，这些工具是在广泛应用植入式心脏复律除颤器（ICD）和心脏再同步治疗（CRT）之前开发的。这些工具在植入 ICD 和/或 CRT 的患者中的预后准确性尚不清楚。
对 715 例 CHF 患者（54±12 岁；ICD 患者 244 例，CRT 患者 30 例，CRT-D 患者 108 例，无器械患者 333 例）进行心肺运动试验，测量最大摄氧量，并计算 HFSS。
平均随访 962±912 天后，354 例患者死亡或接受紧急心脏移植或左心室辅助装置治疗。通过 Cox 风险分析，最大摄氧量和 HFSS 均是强有力的独立预后标志物。通过 Kaplan-Meier 分析，HFSS 在所有器械组中均能有效区分低危、中危和高危患者。相比之下，在器械患者中，最大摄氧量不能区分低危（>14ml/min/kg）和中危（10.1 至 14ml/min/kg）。通过受试者工作特征曲线下面积，HFSS 的性能优于最大摄氧量（总队列 1 年；0.72 比 0.65；p<0.001；器械患者 1 年；0.69 比 0.65；p<0.001）。
HFSS 在存在 ICD 和/或 CRT 的情况下，在 CHF 风险分层方面优于最大摄氧量。此外，在器械时代，最大摄氧量≤10ml/kg/min 可能比传统的≤14ml/kg/min 更有助于风险分层。
