Division of Cardiology, University of Washington, Seattle.
Circ Heart Fail. 2014 Jan;7(1):88-95. doi: 10.1161/CIRCHEARTFAILURE.113.000404. Epub 2013 Nov 26.
Risk stratification is an integral component of clinical decision making in heart failure (HF). Women with HF have unique characteristics compared with men, and it is unknown whether common prognostic factors are equally useful in both populations. We aimed to investigate whether sex-specific risk models are more accurate for risk prediction in patients with advanced HF.
Patients with advanced HF referred to University of California, Los Angeles (UCLA; n=2255), were stratified by sex into derivation (referred in 2000-2007) and validation (referred in 2008-2011) cohorts. Cox regression analysis was used to ascertain key variables predictive of the primary end point of death/urgent transplantation/ventricular assist device in the derivation cohorts and confirmed in the validation cohorts in men, women, and the total population. Women were younger, with higher ejection fraction and better event-free survival. Despite differences in baseline characteristics, the 4 strongest predictors of outcome in both women and men, as well as in the total cohort, were B-type natriuretic peptide, peak oxygen consumption by cardiopulmonary exercise testing (pkVO2), New York Heart Association (NYHA) classification, and use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. In addition, the UCLA model performed better than the Seattle Heart Failure Model (SHFM) and the Heart Failure Survival Score (HFSS) in our cohort (c-indices of 0.791[UCLA] versus 0.758 [SHFM], 0.607 [noninvasive HFSS], and 0.625 [invasive HFSS]).
A simple risk model assessing 4 clinical variables-B-type natriuretic peptide, pkVO2, NYHA, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use-is well suited to provide prognostic information in both men and women with advanced HF.
风险分层是心力衰竭（HF）临床决策的一个组成部分。与男性相比，女性 HF 具有独特的特征，目前尚不清楚在这两种人群中，常见的预后因素是否同样有用。我们旨在研究是否特定于性别的风险模型更能准确预测晚期 HF 患者的风险。
加利福尼亚大学洛杉矶分校（UCLA；n=2255）的晚期 HF 患者按性别分为推导（2000-2007 年就诊）和验证（2008-2011 年就诊）队列。Cox 回归分析用于确定推导队列中主要终点（死亡/紧急移植/心室辅助装置）的预测关键变量，并在男性、女性和总人群的验证队列中得到证实。女性更年轻，射血分数更高，无事件生存率更好。尽管存在基线特征差异，但在女性和男性以及总队列中，预后的 4 个最强预测因素是 B 型利钠肽、心肺运动试验（pkVO2）的峰值摄氧量、纽约心脏协会（NYHA）分类和血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂的使用。此外，与西雅图心力衰竭模型（SHFM）和心力衰竭生存评分（HFSS）相比，UCLA 模型在我们的队列中表现更好（UCLA 的 c 指数为 0.791，SHFM 为 0.758，非侵入性 HFSS 为 0.607，侵入性 HFSS 为 0.625）。
一种简单的风险模型，评估 4 个临床变量-B 型利钠肽、pkVO2、NYHA 和血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的使用-非常适合为男性和女性晚期 HF 患者提供预后信息。
