title: Echocardiography and risk prediction in advanced heart failure: incremental value over clinical markers.
abstract: BACKGROUND
  Incremental value of echocardiography over clinical parameters for outcome prediction in advanced heart failure (HF) is not well established.
  
  
  RESULTS
  We evaluated 223 patients with advanced HF receiving optimal therapy (91.9% angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, 92.8% beta-blockers, 71.8% biventricular pacemaker, and/or defibrillator use). The Seattle Heart Failure Model (SHFM) was used as the reference clinical risk prediction scheme. The incremental value of echocardiographic parameters for event prediction (death or urgent heart transplantation) was measured by the improvement in fit and discrimination achieved by addition of standard echocardiographic parameters to the SHFM. After a median follow-up of 2.4 years, there were 38 (17.0%) events (35 deaths; 3 urgent transplants). The SHFM had likelihood ratio (LR) chi(2) 32.0 and C statistic 0.756 for event prediction. Left ventricular end-systolic volume, stroke volume, and severe tricuspid regurgitation were independent echocardiographic predictors of events. The addition of these parameters to SHFM improved LR chi(2) to 72.0 and C statistic to 0.866 (P < .001 and P=.019, respectively). Reclassifying the SHFM-predicted risk with use of the echocardiography-added model resulted in improved prognostic separation.
  
  
  CONCLUSIONS
  Addition of standard echocardiographic variables to the SHFM results in significant improvement in risk prediction for patients with advanced HF.
authors.affiliation: Cardiology Division, Emory University Hospital, Emory University, Atlanta, GA 30322, USA.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Agha
authors.forename: Andreas P
authors.initials: AP
authors.lastname: Kalogeropoulos
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Shih
authors.forename: Vasiliki V
authors.initials: VV
authors.lastname: Georgiopoulou
authors.forename: Grigorios
authors.initials: G
authors.lastname: Giamouzis
authors.forename: Perry
authors.initials: P
authors.lastname: Anarado
authors.forename: Deepa
authors.initials: D
authors.lastname: Mangalat
authors.forename: Imad
authors.initials: I
authors.lastname: Hussain
authors.forename: Wendy
authors.initials: W
authors.lastname: Book
authors.forename: Sonjoy
authors.initials: S
authors.lastname: Laskar
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Smith
authors.forename: Randolph
authors.initials: R
authors.lastname: Martin
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D015331:Cohort Studies; D004452:Echocardiography / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
chemical_list: D015415:Biomarkers