Sherrod Charles F, Spertus John A, Gosch Kensey L, Wang Andrew, Elliott Perry M, Lakdawala Neal K, Reaney Matthew, Zhong Yue, Lam Jenny, Wyrwich Kathleen W, Sauer Andrew J
University of Missouri - Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
Duke University School of Medicine, Durham, North Carolina.
J Card Fail. 2025 Feb;31(2):481-484. doi: 10.1016/j.cardfail.2024.08.061. Epub 2024 Sep 28.
In order to identify candidacy and treatment response for patients with obstructive hypertrophic cardiomyopathy (oHCM), clinicians need an accurate means of assessing symptoms, function, and quality of life. While the New York Heart Association (NYHA) Classification is most often used for this purpose, the Kansas City Cardiomyopathy Questionnaire (KCCQ-23) is more accurate and sensitive to change, although less familiar to practicing clinicians. To support interpreting the KCCQ-23, we describe cross-sectional and longitudinal changes in KCCQ scores in the context of the NYHA.
Participants from the EXPLORER-HCM trial (NCT03470545) completed the KCCQ-23 and clinicians assigned NYHA classes at study visits. Participants were included if they had baseline and week 30 data for cross-sectional and longitudinal changes. Median KCCQ-23 scores were compared by NYHA class at baseline and week 30 and by change in NYHA class from baseline to week 30.
Cross-sectionally, the KCCQ-23 Overall Summary Scores (KCCQ-23 OSS) and Clinical Summary Scores (KCCQ-23 CSS) had an inverse relationship with the NYHA class at baseline and 30 weeks, with marked variations in KCCQ-23 scores among patients assigned to the same NYHA class. When improving from NYHA class II to I, the median changes in KCCQ-23 OSS and KCCQ-23 CSS were 10 (IQR 4, 22) and 8 (IQR 2, 20), respectively. The changes were larger when improving from NYHA class III to II and from NYHA class III to I.
KCCQ-23 scores are inversely related to NYHA classes, with significant variability within classes. Changes in scores are not linear, suggesting greater differences when patients move between NYHA Classes II and III than when moving between Classes I and II. These insights may help clinicians better understand cross-sectional and longitudinal changes in KCCQ scores.
为了确定梗阻性肥厚型心肌病（oHCM）患者的候选资格和治疗反应，临床医生需要一种准确的方法来评估症状、功能和生活质量。虽然纽约心脏协会（NYHA）分级最常用于此目的，但堪萨斯城心肌病问卷（KCCQ-23）更准确且对变化更敏感，尽管执业临床医生对此不太熟悉。为了支持对KCCQ-23的解读，我们在NYHA的背景下描述了KCCQ评分的横断面和纵向变化。
来自EXPLORER-HCM试验（NCT03470545）的参与者完成了KCCQ-23，临床医生在研究访视时指定NYHA分级。如果参与者有用于横断面和纵向变化的基线和第30周数据，则将其纳入。在基线和第30周时，按NYHA分级比较KCCQ-23评分中位数，并比较从基线到第30周NYHA分级的变化。
横断面来看，KCCQ-23总体总结评分（KCCQ-23 OSS）和临床总结评分（KCCQ-23 CSS）在基线和30周时与NYHA分级呈负相关，在被指定为相同NYHA分级的患者中，KCCQ-23评分存在显著差异。从NYHA II级改善到I级时，KCCQ-23 OSS和KCCQ-23 CSS的中位数变化分别为10（四分位间距4, 22）和8（四分位间距2, 20）。从NYHA III级改善到II级以及从NYHA III级改善到I级时，变化更大。
KCCQ-23评分与NYHA分级呈负相关，各分级内存在显著变异性。评分变化不是线性的，这表明患者在NYHA II级和III级之间转换时的差异大于在I级和II级之间转换时的差异。这些见解可能有助于临床医生更好地理解KCCQ评分的横断面和纵向变化。
