Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
JACC Heart Fail. 2016 Dec;4(12):950-958. doi: 10.1016/j.jchf.2016.07.014. Epub 2016 Sep 7.
This study sought to assess the performance of the HeartMate Risk Score (HMRS) in a large multicenter cohort, with a focus on its performance as a function of disease severity.
The HMRS has been proposed as a simple tool for risk stratification of LVAD recipients, but subsequent studies have challenged its validity.
We performed a retrospective, longitudinal, comparative study using the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) database. The HMRS was calculated for each patient and its association with mortality was assessed using Cox models, including a pre-specified interaction by INTERMACS profile groups (1 vs. 2 vs. 3 vs 4+).
Among 10,847 patients with a mean age of 57.0 ± 12.9 years, 78.9 % were male; and 14.1%, 37.4%, 30.4%, and 18.2% were in INTERMACS profile groups 1, 2, 3, and ≥4, respectively. The HMRS showed moderate discrimination for both short-term (90-day, C-index 0.62) and long-term (2-years, C-index 0.60) mortality, with no significant difference between axial and centrifugal devices. Patients in the highest HMRS group had a relative risk of 90-day mortality 2.8 times greater than those in the lowest HMRS group (13.0% vs. 4.7%; p < 0.001). Importantly, the relative risks of higher HMRS scores were similar across INTERMACS profile groups, with subgroups of patients in INTERMACS profile 1 and 2 having comparable or lower mortality than some in INTERMACS profile 4+.
The HMRS is a valid means of risk-stratifying patients across all INTERMACS profiles and may be superior to traditional INTERMACS classification. Risk stratification with the HMRS showed that patients within each INTERMACS profile groups have a wide spectrum of mortality risk and low INTERMACS profiles should therefore not be considered a contraindication to mechanical support.
本研究旨在评估 HeartMate 风险评分（HMRS）在大型多中心队列中的表现，重点关注其作为疾病严重程度的函数的表现。
HMRS 已被提出作为 LVAD 受者风险分层的简单工具，但随后的研究对其有效性提出了质疑。
我们使用 INTERMACS（机械辅助循环支持机构注册处）数据库进行了回顾性、纵向、比较研究。为每位患者计算了 HMRS，并使用 Cox 模型评估其与死亡率的关联，包括按 INTERMACS 配置文件组（1 与 2 与 3 与≥4）预先指定的交互作用。
在 10847 名平均年龄为 57.0±12.9 岁的患者中，78.9%为男性；INTERMACS 配置文件组分别为 1、2、3 和≥4 的患者分别占 14.1%、37.4%、30.4%和 18.2%。HMRS 在短期（90 天，C 指数 0.62）和长期（2 年，C 指数 0.60）死亡率方面均具有中等的区分能力，轴流和离心设备之间无显著差异。HMRS 最高组的患者 90 天死亡率的相对风险是 HMRS 最低组的 2.8 倍（13.0%比 4.7%；p<0.001）。重要的是，较高 HMRS 评分的相对风险在 INTERMACS 配置文件组之间相似，INTERMACS 配置文件 1 和 2 中的患者亚组的死亡率与某些 INTERMACS 配置文件 4+的死亡率相当或更低。
HMRS 是一种在所有 INTERMACS 配置文件中对患者进行风险分层的有效方法，可能优于传统的 INTERMACS 分类。HMRS 风险分层显示，每个 INTERMACS 配置文件组内的患者具有广泛的死亡率风险，因此低 INTERMACS 配置文件不应被视为机械支持的禁忌症。
