Imamura Teruhiko, Narang Nikhil, Onoda Hiroshi, Tanaka Shuhei, Ushijima Ryuichi, Sobajima Mitsuo, Fukuda Nobuyuki, Ueno Hiroshi, Kinugawa Koichiro
The Second Department of Internal Medicine, University of Toyama, Toyama 9300194, Japan.
Advocate Christ Medical Center, Oak Lawn, IL 60453, USA.
J Clin Med. 2021 Dec 11;10(24):5807. doi: 10.3390/jcm10245807.
The Seattle heart failure model (SHFM) score is a well-known risk predictor of mortality in patients with heart failure. We validated this score in patients receiving transcatheter aortic valve replacement (TAVR) and aimed to generate further risk discrimination by adding invasive hemodynamics parameters.
Patients who underwent TAVR at our institute between 2015 and 2020 were included and followed for 2 years from index discharge. Patients were randomly assigned to the derivation cohort or the validation cohort. In the derivation cohort, the original SHFM score was modified by adding baseline hemodynamics parameters to evaluate the primary outcomes: 2-year incidence of mortality or readmission from heart failure. The model performance of the modified SHFM score was evaluated in the validation cohort.
A total of 217 patients (median age: 86 (83, 88) years old, 64 (29%) men) were included. From the derivation cohort (N = 108), a novel modified SHFM score was constructed: 6 × (original SHFM score < 88.1%) + 5 × (pulmonary capillary wedge pressure > 14 mmHg) + 4 × (cardiac index < 2.26 L/min/m), which had an improved discrimination compared with the original model (area under the curve: 0.887 vs. 0.679, = 0.014). In the validation cohort ( = 109), the modified SHFM score showed accurate predictive discrimination of the 2-year cumulative incidence of the primary endpoint into three groups (a low score group with 0-5 points, 3%; an intermediate score group with 6-10 points, 12%; and a high score group with 11-15 points, 43%, < 0.001).
A modified SHFM score consisting of the original SHFM score and invasive hemodynamics parameters predicted mortality and morbidity following TAVR. Evaluation of the external validity of this score in other cohorts needs further investigation.
西雅图心力衰竭模型（SHFM）评分是心力衰竭患者死亡率的著名风险预测指标。我们在接受经导管主动脉瓣置换术（TAVR）的患者中验证了该评分，并旨在通过添加有创血流动力学参数来进一步提高风险辨别能力。
纳入2015年至2020年在我院接受TAVR的患者，并从出院之日起随访2年。患者被随机分配到推导队列或验证队列。在推导队列中，通过添加基线血流动力学参数来修改原始SHFM评分，以评估主要结局：2年死亡率或因心力衰竭再入院的发生率。在验证队列中评估修改后的SHFM评分的模型性能。
共纳入217例患者（中位年龄：86（83，88）岁，64例（29%）为男性）。从推导队列（N = 108）中构建了一个新的修改后的SHFM评分：6×（原始SHFM评分<88.1%）+5×（肺毛细血管楔压>14 mmHg）+4×（心脏指数<2.26 L/min/m²），与原始模型相比，其辨别能力有所提高（曲线下面积：0.887对0.679，P = 0.014）。在验证队列（n = 109）中，修改后的SHFM评分对主要终点的2年累积发生率进行了准确的预测辨别，分为三组（低分组合计0 - 5分，占3%；中等分组合计6 - 10分，占12%；高分组合计11 - 15分，占43%，P < 0.001）。
由原始SHFM评分和有创血流动力学参数组成的修改后的SHFM评分可预测TAVR后的死亡率和发病率。该评分在其他队列中的外部有效性评估需要进一步研究。
