Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
Am J Cardiol. 2019 Jul 1;124(1):55-62. doi: 10.1016/j.amjcard.2019.03.041. Epub 2019 Apr 9.
In recent years, many prognostic scores have been developed for advanced chronic heart failure (CHF), but none of them is comprised of first- and second level echocardiographic indexes. The aim was to create a new prognostic echocardiographic score for patients with advanced CHF. Patients with advanced CHF were analyzed by standard, 3D, and speckle tracking echocardiography and followed prospectively for 2 ± 0.7 years recording major adverse cardiac events (MACE): cardiovascular death, hospitalization for HF, emergency heart transplantation, and left ventricular assist device or intra-aortic balloon pump implantation. A total of 110 patients were enrolled. The best predictors of MACE were selected on the basis of area under the curve by receiver operating characteristic analysis >0.70: left atrial volume index (no MACE vs MACE groups, 51.3 ± 20 ml/m vs 67 ± 20 ml/m, p = 0.0003), right ventricular sphericity index (0.53 ± 0.09 vs 0.61 ± 0.10, p = 0.0002), right ventricular fractional area change (41 ± 9% vs 33 ± 9.5, p <0.0001), free-wall right ventricular longitudinal strain (-20 ± 4.5% vs -16 ± 6%, p = 0.0013). A prognostic score formula was calculated as: PROBE score = 1(if left atrial volume index >65 ml/m) + 1(if right ventricular sphericity index >0.53) + 0.5(if right ventricular fractional area change <36.5%) + 1(if free-wall right ventricular longitudinal strain >-14%). It presented an area under the curve by receiver operating characteristic analysis of 0.90 and classified patients at low (PROBE ≤1), intermediate (PROBE = 1 to 2), or high (PROBE >2) risk of MACE. The Kaplan-Meier analysis revealed a strong correlation between the event-free survival rate and the 3 groups. In conclusion, the PROBE score, with first- and second level echocardiographic parameters, demonstrated a good predictive value for MACE. It represents a useful tool for a noninvasive, individualized, and accurate evaluation and stratification of prognosis in patients with advanced CHF.
近年来，许多用于诊断慢性心力衰竭（CHF）的预后评分已被开发出来，但均未包含一、二级超声心动图指标。本研究旨在创建一个新的用于诊断慢性心力衰竭的超声心动图预后评分。
通过标准、3D 和斑点追踪超声心动图对晚期 CHF 患者进行分析，并前瞻性随访 2±0.7 年，记录主要不良心脏事件（MACE）：心血管死亡、心力衰竭住院、紧急心脏移植、左心室辅助装置或主动脉内球囊泵植入。共纳入 110 例患者。基于受试者工作特征曲线下面积（AUC）>0.70 选择最佳的 MACE 预测指标：左心房容积指数（无 MACE 组 vs MACE 组，51.3±20 ml/m vs 67±20 ml/m，p=0.0003）、右心室球形指数（0.53±0.09 vs 0.61±0.10，p=0.0002）、右心室射血分数（41±9% vs 33±9.5%，p<0.0001）、游离壁右心室纵向应变（-20±4.5% vs -16±6%，p=0.0013）。
PROBE 评分=1（如果左心房容积指数>65 ml/m）+1（如果右心室球形指数>0.53）+0.5（如果右心室射血分数<36.5%）+1（如果游离壁右心室纵向应变>-14%）。受试者工作特征曲线下面积（AUC）为 0.90，将患者分为低危（PROBE≤1）、中危（PROBE=1 至 2）或高危（PROBE>2）三组。
Kaplan-Meier 分析显示，无事件生存率与三组之间存在很强的相关性。
总之，PROBE 评分结合了一、二级超声心动图参数，对 MACE 具有良好的预测价值。它为晚期 CHF 患者的非侵入性、个体化和准确评估及预后分层提供了一个有用的工具。
