期刊
INTERNATIONAL JOURNAL OF CARDIOLOGY
卷 284, 期 -, 页码 42-49出版社
ELSEVIER IRELAND LTD
DOI: 10.1016/j.ijcard.2018.10.076
关键词
Heart failure; Left ventricular ejection fraction; HFpEF; Prognosis; Risk score
资金
- Japanese Ministry of Health, Labour andWelfare
- Japanese Ministry of Education, Culture, Sports, Science and Technology
- Japan Agency for Medical Research and Development, Tokyo, Japan [15ek0210043h0001, 16ek0210056h0001, 16ek0210043h0002]
- National Heart, Lung, and Blood Institute, National Institutes of Health [HHSN268200425207C]
- National Medical Research Council of Singapore
- Agency for Science, Technology and Research Biomedical Research Council Asian Network for Translational Research and Cardiovascular Trials program
- Boston Scientific Investigator Sponsored Research Program
- Bayer
Background: Few simple risk models, without echocardiography have been developed for patients with heart failure (HF) and preserved left ventricular ejection fraction (LVEF) (HFpEF). Methods: To develop a risk score to predict all-cause death for HFpEF patients, we examined 1277 HF patients with LVEF >= 50% and BNP >= 100 pg/ml in the CHART-2 Study, a large-scale prospective cohort study for HF in Japan. We selected the optimal subset of covariates for the score with Cox proportional hazard models and random survival forests (RSF). Results: During the median 5.7-year follow-up, 576 deaths occurred. Cox models and RSF analyses consistently indicated age >= 75 years, albumin <3.7 g/dl, anemia, BMI <22 kg/m(2), BNP >= 300 pg/ml (or NT-proBNP >= 1400 pg/ml), and BUN >= 25 mg/dl, as the important 6 prognostic variables. Incorporating these 6 variables, we developed a scoring system (3A3B score, with 2 points given to age >= 75 years and 1 point to the others based on the hazard ratios. The discrimination ability of the risk score was excellent (c-index 0.708). Regarding model goodness-of-fit, the overall gradient in 5-year risk was well captured by the score. The predictive accuracy of the 3A3B score was confirmed in the external validation cohorts from the TOPCAT trial (N=835, c-index 0.652) and the ASIAN-HF registry (N=170, c-index 0.741). Conclusions: We developed a simple risk score to predict long-term prognosis of HFpEF patients. The 3A3B score, comprising 6 commonly available parameters in daily practice, has potential utility in the risk stratification and management of HFpEF patients. (c) 2018 Elsevier B.V. All rights reserved.
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