Prognostic impact of the addition of peak oxygen consumption to the Seattle Heart Failure Model in a transplant referral population

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• 作者：Wayne C. Levy ; Keith D. Aaronson ; Todd F. Dardas ; Paula Williams ; Jennifer Haythe ; Donna Mancini
• 关键词：heart failure ; prognosis ; peak oxygen consumption ; Seattle Heart Failure Model ; transplantation ; left ventricular assist device
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2012
• 出版时间：August, 2012
• 年：2012
• 卷：31
• 期：8
• 页码：817-824
• 全文大小：877 K

文摘

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Background

In this study we investigated whether the addition of peak oxygen consumption (VO₂) improves the predictive accuracy of the Seattle Heart Failure Model (SHFM). The SHFM is a validated multivariate risk model that uses NYHA classification to assess functional capacity rather than peak oxygen consumption (VO₂).

Methods

Outpatients (n = 1,240) evaluated for transplant at three centers had their SHFM score calculated and peak VO₂ measured. The outcomes assessed were death/LVAD/urgent transplant with censoring at the time of elective transplant.

Results

Over the course of 4.0 (mean) years of observation, there were 571 events. Both the SHFM score (¦Ö² = 227) and peak VO₂ (¦Ö² = 88, both p < 0.0001) were highly predictive of outcomes. The SHFM and peak VO₂ were modestly correlated (r = 0.39, p < 0.0001). In a multivariate Cox model, peak VO₂ added to the SHFM with a hazard ratio of 0.949 (p < 0.0001) for each 1-ml/kg/min increase. Peak VO₂ improved both the net reclassification improvement and integrated discrimination index (both p ¡Ü 0.0002). Peak VO₂ provided additive prognostic information within each SHFM score (p < 0.05). The 1-year areas under the receiver-operating characteristic curve were obtained for peak VO₂ (0.645, 95 % CI 0.606 to 0.684), SHFM (0.758, 95 % CI 0.721 to 0.795) and SHFM with peak VO₂ (0.766, 95 % CI 0.731 to 0.802). The SHFM-predicted vs actual survival free of LVAD/UNOS Status 1 transplant at 1 year (86 % vs 83 % ) and 4 years (63 % vs 63 % ) were similar.

Conclusions

The multivariate SHFM is a powerful predictor of death/LVAD/urgent transplant. Peak VO₂ adds prognostic information across the spectrum of the SHFM, but changes in decision regarding transplant listing occur mainly in moderate-risk patients.