title: The etiology-filling pattern-pulmonary artery pressure score: a simple tool for risk stratification of patients with systolic heart failure.
abstract: 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 t 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 (P=.004), ischemic etiology (P=.022), pulmonary artery systolic pressure (PASP) ≥50 mm Hg (P=.027), and peak oxygen uptake (VO(2) ) <15.9 mL/kg/min (P=.046) resulted independent predictors of the outcome. A simple risk score was then obtained using these significant independent variables, excluding peak VO(2) 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; P<.001, compared with patients with no risk factors). In this high-risk group, evaluation of peak VO(2) 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.
authors.affiliation: Department of Cardiology, Rapallo Hospital, Rapallo, Italy. avallebona@asl4.liguria.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vallebona
authors.forename: Guido
authors.initials: G
authors.lastname: Gigli
authors.forename: Sandro
authors.initials: S
authors.lastname: Orlandi
authors.forename: Davide
authors.initials: D
authors.lastname: Orlandi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Gigli
authors.forename: Giorgio
authors.initials: G
authors.lastname: Reggiardo
mesh_terms: D000368:Aged; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005260:Female; D054143:Heart Failure, Systolic / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009017:Morbidity / Q000639:trends; D011379:Prognosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends; D016277:Ventricular Function, Left / Q000502:physiology*