Division of Cardiology, University of Washington,1959 NE Pacific Street, Seattle, WA 98195, USA.
J Heart Lung Transplant. 2012 Aug;31(8):817-24. doi: 10.1016/j.healun.2012.04.006.
In this study we investigated whether the addition of peak oxygen consumption (VO(2)) improves the predictive accuracy of the Seattle Heart Failure Model (SHFM). The SHFM is a validated multivariate risk model that uses NYHA classification to assess functional capacity rather than peak oxygen consumption (VO(2)).
Outpatients (n = 1,240) evaluated for transplant at three centers had their SHFM score calculated and peak VO(2) measured. The outcomes assessed were death/LVAD/urgent transplant with censoring at the time of elective transplant.
Over the course of 4.0 (mean) years of observation, there were 571 events. Both the SHFM score (χ(2) = 227) and peak VO(2) (χ(2) = 88, both p < 0.0001) were highly predictive of outcomes. The SHFM and peak VO(2) were modestly correlated (r = 0.39, p < 0.0001). In a multivariate Cox model, peak VO(2) added to the SHFM with a hazard ratio of 0.949 (p < 0.0001) for each 1-ml/kg/min increase. Peak VO(2) improved both the net reclassification improvement and integrated discrimination index (both p ≤ 0.0002). Peak VO(2) provided additive prognostic information within each SHFM score (p < 0.05). The 1-year areas under the receiver-operating characteristic curve were obtained for peak VO(2) (0.645, 95% CI 0.606 to 0.684), SHFM (0.758, 95% CI 0.721 to 0.795) and SHFM with peak VO(2) (0.766, 95% CI 0.731 to 0.802). The SHFM-predicted vs actual survival free of LVAD/UNOS Status 1 transplant at 1 year (86% vs 83%) and 4 years (63% vs 63%) were similar.
The multivariate SHFM is a powerful predictor of death/LVAD/urgent transplant. Peak VO(2) adds prognostic information across the spectrum of the SHFM, but changes in decision regarding transplant listing occur mainly in moderate-risk patients.
在这项研究中，我们探讨了是否增加峰值摄氧量（VO2）可以提高西雅图心力衰竭模型（SHFM）的预测准确性。SHFM 是一种经过验证的多变量风险模型，它使用 NYHA 分类来评估功能能力，而不是峰值摄氧量（VO2）。
在三个中心接受移植评估的门诊患者（n=1240）计算了他们的 SHFM 评分并测量了峰值 VO2。评估的结果是死亡/LVAD/紧急移植，选择性移植时进行删失。
在 4.0（平均）年的观察过程中，发生了 571 起事件。SHFM 评分（χ2=227）和峰值 VO2（χ2=88，均 P<0.0001）均高度预测结果。SHFM 和峰值 VO2 中度相关（r=0.39，P<0.0001）。在多变量 Cox 模型中，每增加 1 毫升/公斤/分钟，峰值 VO2 使 SHFM 的风险比增加 0.949（P<0.0001）。峰值 VO2 改善了净重新分类改善和综合鉴别指数（均 P≤0.0002）。在每个 SHFM 评分内，峰值 VO2 提供了附加的预后信息（P<0.05）。获得了峰值 VO2（0.645，95%CI 0.606 至 0.684）、SHFM（0.758，95%CI 0.721 至 0.795）和 SHFM 加峰值 VO2（0.766，95%CI 0.731 至 0.802）的 1 年接受者操作特征曲线下面积。SHFM 预测的与实际的无 LVAD/UNOS 状态 1 移植的 1 年（86% vs 83%）和 4 年（63% vs 63%）生存率相似。
多变量 SHFM 是死亡/LVAD/紧急移植的有力预测指标。峰值 VO2 在 SHFM 的整个范围内增加了预后信息，但移植名单的改变主要发生在中危患者中。
