TY - JOUR
T1 - Risk stratification of ambulatory patients with advanced heart failure undergoing evaluation for heart transplantation
AU - Kato, Tomoko S.
AU - Stevens, Gerin R.
AU - Jiang, Jeffrey
AU - Christian Schulze, P.
AU - Gukasyan, Natalie
AU - Lippel, Matthew
AU - Levin, Alison
AU - Homma, Shunichi
AU - Mancini, Donna
AU - Farr, Maryjane
N1 - Funding Information:
The first and second authors (T.S.K. and G.R.S.) contributed equally to this work. M.F. was supported by the National Center for Advancing Translational Sciences (UL1 RR024156), formerly the National Center for Research Resources, of the National Institutes of Health (UL1 TR000040).
PY - 2013/3
Y1 - 2013/3
N2 - Background: Risk stratification of ambulatory heart failure (HF) patients has relied on peak VO2<14 ml/kg/min. We investigated whether additional clinical variables might further specify risk of death, ventricular assist device (VAD) implantation (INTERMACS <4) or heart transplantation (HTx, Status 1A or 1B) within 1 year after HTx evaluation. We hypothesized that right ventricular stroke work index (RVSWI), pulmonary capillary wedge pressure (PCWP) and the model for end-stage liver disease - albumin score (MELD-A) would be additive prognostic predictors. Methods: We retrospectively collected data on 151 ambulatory patients undergoing HTx evaluation. Primary outcomes were defined as HTx, LVAD or death within 1 year after evaluation. Results: Average age in our cohort was 55 ± 11.1 years, 79.1% were male and 39% had an ischemic etiology (LVEF 21 ± 10.5% and peak VO2 12.6 ± 3.5 ml/kg/min). Fifty outcomes (33.1%) were observed (27 HTxs, 15 VADs and 8 deaths). Univariate logistic regression showed a significant association of RVSWI (OR 0.47, p = 0.036), PCWP (OR 2.65, p = 0.007) and MELD-A (OR 2.73, p = 0.006) with 1-year events. Stepwise regression showed an independent correlation of RVSWI<5 gm-m2/beat (OR 6.70, p < 0.01), PCWP>20 mm Hg (OR 5.48, p < 0.01), MELD-A>14 (OR 3.72, p< 0.01) and peak VO 2<14 ml/kg/min (OR 3.36, p = 0.024) with 1-year events. A scoring system was developed: MELD-A>14 and peak VO2<14 - 1 point each; and PCWP>20 and RVSWI<5 - 2 points each. A cut-off at≥4 demonstrated a 54% sensitivity and 88% specificity for 1-year events. Conclusions: Ambulatory HF patients have significant 1-year event rates. Risk stratification based on exercise performance, left-sided congestion, right ventricular dysfunction and liver congestion allows prediction of 1-year prognosis. Our findings support early and timely referral for VAD and/or transplant.
AB - Background: Risk stratification of ambulatory heart failure (HF) patients has relied on peak VO2<14 ml/kg/min. We investigated whether additional clinical variables might further specify risk of death, ventricular assist device (VAD) implantation (INTERMACS <4) or heart transplantation (HTx, Status 1A or 1B) within 1 year after HTx evaluation. We hypothesized that right ventricular stroke work index (RVSWI), pulmonary capillary wedge pressure (PCWP) and the model for end-stage liver disease - albumin score (MELD-A) would be additive prognostic predictors. Methods: We retrospectively collected data on 151 ambulatory patients undergoing HTx evaluation. Primary outcomes were defined as HTx, LVAD or death within 1 year after evaluation. Results: Average age in our cohort was 55 ± 11.1 years, 79.1% were male and 39% had an ischemic etiology (LVEF 21 ± 10.5% and peak VO2 12.6 ± 3.5 ml/kg/min). Fifty outcomes (33.1%) were observed (27 HTxs, 15 VADs and 8 deaths). Univariate logistic regression showed a significant association of RVSWI (OR 0.47, p = 0.036), PCWP (OR 2.65, p = 0.007) and MELD-A (OR 2.73, p = 0.006) with 1-year events. Stepwise regression showed an independent correlation of RVSWI<5 gm-m2/beat (OR 6.70, p < 0.01), PCWP>20 mm Hg (OR 5.48, p < 0.01), MELD-A>14 (OR 3.72, p< 0.01) and peak VO 2<14 ml/kg/min (OR 3.36, p = 0.024) with 1-year events. A scoring system was developed: MELD-A>14 and peak VO2<14 - 1 point each; and PCWP>20 and RVSWI<5 - 2 points each. A cut-off at≥4 demonstrated a 54% sensitivity and 88% specificity for 1-year events. Conclusions: Ambulatory HF patients have significant 1-year event rates. Risk stratification based on exercise performance, left-sided congestion, right ventricular dysfunction and liver congestion allows prediction of 1-year prognosis. Our findings support early and timely referral for VAD and/or transplant.
KW - heart failure
KW - heart transplant evaluation
KW - mechanical circulatory support
KW - prognosis
KW - right ventricular dysfunction
KW - risk stratification
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U2 - 10.1016/j.healun.2012.11.026
DO - 10.1016/j.healun.2012.11.026
M3 - Article
C2 - 23415315
AN - SCOPUS:84873921602
SN - 1053-2498
VL - 32
SP - 333
EP - 340
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 3
ER -