选择心脏移植患者：心力衰竭生存评分（HFSS）和西雅图心力衰竭模型（SHFM）的比较。
Selecting patients for heart transplantation: comparison of the Heart Failure Survival Score (HFSS) and the Seattle heart failure model (SHFM).
机构信息
Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
出版信息
J Heart Lung Transplant. 2011 Nov;30(11):1236-43. doi: 10.1016/j.healun.2011.05.012. Epub 2011 Jul 20.
BACKGROUND
The Heart Failure Survival Score (HFSS) risk-stratifies patients with chronic heart failure (CHF) referred for heart transplantation using 7 parameters, including peak VO₂. The Seattle Heart Failure Model (SHFM) is a 20-variable model that combines clinical, laboratory and therapeutic data. Although both models have excellent accuracy, only the HFSS was derived and validated in patients referred for transplantation, and the HFSS and SHFM have not been directly compared.
METHODS
We tested the accuracy of the SHFM and compared the HFSS and SHFM in 715 patients referred for heart transplantation.
RESULTS
Over a follow-up of 962 ± 912 days, 354 patients died or received an urgent heart transplantation or a ventricular assist device. One-year event-free survival was 89%, 72% and 60%, respectively, for the low-, medium- and high-risk HFSS strata, and 93%, 76%, and 58%, respectively, for the low-, medium- and high-risk SHFM strata. The HFSS and SHFM were modestly correlated (R = -0.48, p < 0.001). In receiver operating characteristic curve analysis, areas under the curves (AUCs) for the HFSS and SHFM were comparable (1 year: 0.72 vs 0.73; 2-year: 0.70 vs 0.74, respectively) and incremental to New York Heart Association class. The 1- and 2-year combined HFSS+SHFM AUCs were 0.77 and 0.76, respectively, significantly better than the HFSS or SHFM alone.
CONCLUSIONS
The HFSS and SHFM provide accurate and comparable risk stratification in CHF patients referred for transplantation. Combining the HFSS and SHFM improves predictive ability.
背景
心力衰竭生存评分（HFSS）使用 7 个参数（包括峰值 VO₂）对接受心脏移植的慢性心力衰竭（CHF）患者进行风险分层。西雅图心力衰竭模型（SHFM）是一个包含临床、实验室和治疗数据的 20 变量模型。虽然这两种模型都具有出色的准确性，但只有 HFSS 是在接受移植的患者中推导和验证的，HFSS 和 SHFM 尚未直接比较。
方法
我们测试了 SHFM 的准确性，并在 715 名接受心脏移植的患者中比较了 HFSS 和 SHFM。
结果
在 962±912 天的随访中，354 名患者死亡或接受紧急心脏移植、心室辅助装置或心脏移植。低、中、高危 HFSS 分层的 1 年无事件生存率分别为 89%、72%和 60%，低、中、高危 SHFM 分层的 1 年无事件生存率分别为 93%、76%和 58%。HFSS 和 SHFM 中度相关（R=-0.48，p<0.001）。在接收者操作特征曲线分析中，HFSS 和 SHFM 的曲线下面积（AUC）相当（1 年：0.72 与 0.73；2 年：0.70 与 0.74），且优于纽约心脏协会分级。HFSS+SHFM 的 1 年和 2 年 AUC 分别为 0.77 和 0.76，明显优于 HFSS 或 SHFM 单独使用。
结论
HFSS 和 SHFM 为接受移植的 CHF 患者提供了准确且可比的风险分层。结合 HFSS 和 SHFM 可提高预测能力。
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