Thomas Sunu S, Nahumi Nadav, Han Jason, Lippel Matthew, Colombo Paolo, Yuzefpolskaya Melana, Takayama Hiroo, Naka Yoshifumi, Uriel Nir, Jorde Ulrich P
Division of Cardiology, Columbia University Medical Center, New York, New York, USA.
Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York, USA.
J Heart Lung Transplant. 2014 Jul;33(7):675-81. doi: 10.1016/j.healun.2014.02.011. Epub 2014 Feb 14.
Survival with left ventricular assist device (LVAD) therapy is dependent on appropriate patient selection. The HeartMate II risk score (HMRS) was recently derived and validated to predict 90-day mortality in clinical trial patients with continuous-flow LVADs. The aim of this study was to test HMRS validity in predicting survival at our institution.
We performed a retrospective analysis of patients implanted with HeartMate II (HMII; Thoratec, Pleasanton, CA) LVADs from March 31, 2004 to September 20, 2012 at the Columbia University Medical Center (CUMC). Patients were stratified according to HMRS profiles (HMRS Low < 1.58, 1.58 ≤ HMRS Medium ≤ 2.48, HMRS High > 2.48) calculated using age, albumin, creatinine, international normalized ratio (INR) and center volume. Outcome was defined as survival at 90 days after device implantation.
HeartMate II LVADs were implanted in 205 patients. Pre-operative data from 201 patients were categorized into HMRS Low (n = 101; 1.04 [0.64 to 1.31]), HMRS Medium (n = 73; 1.98 [1.78 to 2.25]) and HMRS High (n = 27, 3.07 [2.70 to 3.43]) (p < 0.0001). Kaplan-Meier survival estimates at 90 days (HMRS Low 91.0 ± 2.9%, HMRS Medium 91.7 ± 3.2%, HMRS High 88.7 ± 6.1%) and at 1 year (HMRS Low 85.5 ± 3.8%, HMRS Medium 79.3 ± 5.5%, HMRS High 82.4 ± 8.4%) after LVAD implantation were not statistically different (p = 0.43). Prediction of 90-day mortality by receiver operating characteristic was poor (AUC = 0.56).
HMRS stratification poorly discriminates 90-day mortality after HMII LVAD implantation at our institution. Its generalizability as a universal prognostic score may be limited.
左心室辅助装置（LVAD）治疗的生存率取决于合适的患者选择。最近得出并验证了HeartMate II风险评分（HMRS），以预测接受连续血流LVAD治疗的临床试验患者的90天死亡率。本研究的目的是在我们机构测试HMRS在预测生存率方面的有效性。
我们对2004年3月31日至2012年9月20日在哥伦比亚大学医学中心（CUMC）植入HeartMate II（HMII；Thoratec，普莱森顿，加利福尼亚州）LVAD的患者进行了回顾性分析。根据使用年龄、白蛋白、肌酐、国际标准化比值（INR）和中心血量计算出的HMRS概况（HMRS低＜1.58，1.58≤HMRS中等≤2.48，HMRS高＞2.48）对患者进行分层。结局定义为装置植入后90天的生存率。
205例患者植入了HeartMate II LVAD。201例患者的术前数据被分类为HMRS低（n = 101；1.04[0.64至1.31]）、HMRS中等（n = 73；1.98[1.78至2.25]）和HMRS高（n = 27，3.07[2.70至3.43]）（p＜0.0001）。LVAD植入后90天（HMRS低91.0±2.9%，HMRS中等91.7±3.2%，HMRS高88.7±6.1%）和1年（HMRS低85.5±3.8%，HMRS中等79.3±5.5%，HMRS高82.4±8.4%）的Kaplan-Meier生存估计无统计学差异（p = 0.43）。通过受试者工作特征曲线预测90天死亡率的效果较差（AUC = 0.56）。
在我们机构，HMRS分层对HMII LVAD植入后90天死亡率的区分能力较差。其作为通用预后评分的可推广性可能有限。
