Centro Cardiologicico Monzino, IRCCS, Milano, Italy.
Int J Cardiol. 2013 Sep 10;167(6):2710-8. doi: 10.1016/j.ijcard.2012.06.113. Epub 2012 Jul 15.
We built and validated a new heart failure (HF) prognostic model which integrates cardiopulmonary exercise test (CPET) parameters with easy-to-obtain clinical, laboratory, and echocardiographic variables.
HF prognostication is a challenging medical judgment, constrained by a magnitude of uncertainty.
Our risk model was derived from a cohort of 2716 systolic HF patients followed in 13 Italian centers. Median follow up was 1041days (range 4-5185). Cox proportional hazard regression analysis with stepwise selection of variables was used, followed by cross-validation procedure. The study end-point was a composite of cardiovascular death and urgent heart transplant.
Six variables (hemoglobin, Na(+), kidney function by means of MDRD, left ventricle ejection fraction [echocardiography], peak oxygen consumption [% pred] and VE/VCO2 slope) out of the several evaluated resulted independently related to prognosis. A score was built from Metabolic Exercise Cardiac Kidney Indexes, the MECKI score, which identified the risk of study end-point with AUC values of 0.804 (0.754-0.852) at 1year, 0.789 (0.750-0.828) at 2years, 0.762 (0.726-0.799) at 3years and 0.760 (0.724-0.796) at 4years.
This is the first large-scale multicenter study where a prognostic score, the MECKI score, has been built for systolic HF patients considering CPET data combined with clinical, laboratory and echocardiographic measurements. In the present population, the MECKI score has been successfully validated, performing very high AUC.
我们构建并验证了一个新的心衰（HF）预后模型，该模型将心肺运动试验（CPET）参数与易于获得的临床、实验室和超声心动图变量相结合。
HF 的预后预测是一项具有挑战性的医学判断，受到大量不确定性的限制。
我们的风险模型来自于一个由 2716 例收缩性 HF 患者组成的队列，这些患者在意大利的 13 个中心接受了随访。中位随访时间为 1041 天（范围 4-5185 天）。采用逐步选择变量的 Cox 比例风险回归分析，然后进行交叉验证。研究终点是心血管死亡和紧急心脏移植的复合终点。
在评估的多个变量中，有 6 个变量（血红蛋白、Na(+)、通过 MDRD 评估的肾功能、左心室射血分数[超声心动图]、峰值摄氧量 [% 预测值]和 VE/VCO2 斜率）与预后独立相关。从代谢运动心脏肾脏指数中构建了一个评分，即 MECKI 评分，该评分在 1 年时识别研究终点的风险的 AUC 值为 0.804（0.754-0.852），在 2 年时为 0.789（0.750-0.828），在 3 年时为 0.762（0.726-0.799），在 4 年时为 0.760（0.724-0.796）。
这是第一项大型多中心研究，为收缩性 HF 患者构建了一个预后评分，即 MECKI 评分，该评分考虑了 CPET 数据与临床、实验室和超声心动图测量相结合。在本研究人群中，MECKI 评分已成功验证，具有非常高的 AUC。
