The Etiology‐Filling Pattern‐Pulmonary Artery Pressure Score: A Simple Tool for Risk Stratification of Patients with Systolic Heart Failure. Issue 1 (16th April 2012)

• Record Type: Journal Article
• Authors: Vallebona, Alessandro; Gigli, Guido; Orlandi, Sandro; Orlandi, Davide; Gigli, Lorenzo; Reggiardo, Giorgio
• Is Part Of: Congestive heart failure. Volume 19:Issue 1(2013:Jan./Feb.)
• Page Start: 39
• Page End: 43
• Publication Date: 2012-04-16
• Subjects: Congestive heart failure -- Periodicals; 616.129
• DOI: 10.1111/j.1751-7133.2012.00294.x
• Languages: English
• ISSNs: 1527-5299

Abstract

<abstract abstract-type="main" xml:lang="en"> <title> <x xml:space="preserve">Abstract</x> </title> <p>©2012 Wiley Periodicals, Inc.</p> <p>Heart failure (HF) is a leading cause of morbidity and mortality. The detection of patients at high risk for death is a major challenge in HF management. The authors compared the prognostic value of 23 clinical Doppler echocardiography and cardiopulmonary exercise indexes in a stable, moderately symptomatic, systolic HF outpatient population receiving optimal medical therapy. The end point was the incidence of overall mortality. Between January 2002 and December 2008, a total of 146 patients with left ventricular (LV) ejection fraction 0.31±0.8 and New York Heart Association functional class II or III were enrolled. The prognostic power of single variables was assessed using chi‐square test for categoric variables and <italic>t</italic> test for continuous variables. Variables associated with the prespecified end point were included as predictors in a binary logistic regression multivariate model. At multivariate analysis, "restrictive" LV filling pattern (<italic>P</italic>=.004), ischemic etiology (<italic>P</italic>=.022), pulmonary artery systolic pressure (PASP) ≥50 mm Hg (<italic>P</italic>=.027), and peak oxygen uptake (VO<sub>2</sub>) <15.9 mL/kg/min (<italic>P</italic>=.046) resulted independent predictors of the outcome. A simple risk score was then obtained using these significant independent variables, excluding peak VO<sub>2</sub> because of only borderline significance. Patients with ischemic etiology, restrictive LV filling pattern, and PASP ≥50 mm Hg have a very high risk of death (odds ratio, 33.77; 95% confidence interval, 5.74–198.8; <italic>P</italic><.001, compared with patients with no risk factors). In this high‐risk group, evaluation of peak VO<sub>2</sub> could be superfluous. A very simple clinical echocardiographic model based on etiology‐LV filling and pulmonary pressure is a powerful tool for risk stratification of systolic HF in ambulatory patients.</p> </abstract>