(Circulation. 1997;95:2660-2667.)
© 1997 American Heart Association, Inc.
Articles |
Development and Prospective Validation of a Clinical Index to Predict Survival in Ambulatory Patients Referred for Cardiac Transplant Evaluation
From the Division of Circulatory Physiology, Heart Failure and Cardiac Transplant Programs, College of Physicians and Surgeons, Columbia University (K.D.A., D.M.M.), New York, NY, and the Division of General Medicine and the Leonard Davis Institute for Health Economics (J.S.S.), University of Pennsylvania School of Medicine (J.S.S., T.-M.C., K.-L.W., J.E.G.), Philadelphia.
Correspondence to Dr Keith D. Aaronson, Division of Cardiology, University of Michigan Medical Center, Taubman 3910, Ann Arbor, MI 48109-0366. E-mail keith{at}umich.edu
Background Risk stratification of patients with end-stage congestive heart failure is a critical component of the transplant candidate selection process. Accurate identification of individuals most likely to survive without a transplant would facilitate more efficient use of scarce donor organs.
Methods and Results Multivariable proportional hazards survival models were developed with the use of data on 80 clinical characteristics from 268 ambulatory patients with advanced heart failure (derivation sample). Invasive and noninvasive models (with and without catheterization-derived data) were constructed. A prognostic score was determined for each patient from each model. Stratum-specific likelihood ratios were used to develop three prognostic-score risk groups. The models were prospectively validated on 199 similar patients (validation sample) by calculation of the area under the receiver operating characteristic curve for 1-year event-free survival, the censored c-index for event-free survival, and comparison of event-free survival curves for prognostic-score risk strata. Outcome events were defined as urgent transplant or death without transplant. The noninvasive model performed well in both samples, and increased performance was not attained by the addition of catheterization-derived variables. Prognostic-score risk groups derived from the noninvasive model in the derivation sample effectively stratified the risk of an outcome event in both samples (1-year event-free survival for derivation and validation samples, respectively: low risk, 93% and 88%; medium risk, 72% and 60%; high risk, 43% and 35%).
Conclusions Selection of candidates for cardiac transplantation may be improved by use of this noninvasive risk-stratification model.
Key Words: heart failure • survival • risk factors • predictive models
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F. A. McAlister, J. A. Ezekowitz, N. Wiebe, B. Rowe, C. Spooner, E. Crumley, L. Hartling, T. Klassen, and W. Abraham Systematic Review: Cardiac Resynchronization in Patients with Symptomatic Heart Failure Ann Intern Med, September 7, 2004; 141(5): 381 - 390. [Abstract] [Full Text] [PDF]
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J. Martin, M. P. Siegenthaler, O. Friesewinkel, T. Fader, A. van de Loo, G. Trummer, M. Berchtold-Herz, and F. Beyersdorf Implantable left ventricular assist device for treatment of pulmonary hypertension in candidates for orthotopic heart transplantation--a preliminary study Eur. J. Cardiothorac. Surg., June 1, 2004; 25(6): 971 - 977. [Abstract] [Full Text] [PDF]
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P. de Groote, J. Dagorn, B. Soudan, N. Lamblin, E. McFadden, and C. Bauters B-type natriuretic peptide and peak exercise oxygen consumption provide independent information for risk stratification in patients with stable congestive heart failure J. Am. Coll. Cardiol., May 5, 2004; 43(9): 1584 - 1589. [Abstract] [Full Text] [PDF]
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N. R. Shah, J. G. Rogers, G. A. Ewald, M. K. Pasque, E. M. Geltman, M. S. Bailey, and N. Moazami Survival of patients removed from the heart transplant waiting list J. Thorac. Cardiovasc. Surg., May 1, 2004; 127(5): 1481 - 1485. [Abstract] [Full Text] [PDF]
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J. Butler, G. Khadim, K. M. Paul, S. F. Davis, M. W. Kronenberg, D. B. Chomsky, R. N. Pierson III, and J. R. Wilson Selection of patients for heart transplantationin the current era of heart failure therapy J. Am. Coll. Cardiol., March 3, 2004; 43(5): 787 - 793. [Abstract] [Full Text] [PDF]
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E. F. Lewis, S. W. Tsang, J. C. Fang, G. H. Mudge, J. A. Jarcho, C. M. Flavell, A. Nohria, M. M. Givertz, G. S. Couper, J. G. Byrne, et al. Frequency and impact of delayed decisions regarding heart transplantation on long-term outcomes in patients with advanced heart failure J. Am. Coll. Cardiol., March 3, 2004; 43(5): 794 - 802. [Abstract] [Full Text] [PDF]
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M. C. Deng Heart transplantation: the increasing challenges of evidence-based decision-making J. Am. Coll. Cardiol., March 3, 2004; 43(5): 803 - 805. [Full Text] [PDF]
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F. A. McAlister, J. Ezekowitz, M. Tonelli, and P. W. Armstrong Renal Insufficiency and Heart Failure: Prognostic and Therapeutic Implications From a Prospective Cohort Study Circulation, March 2, 2004; 109(8): 1004 - 1009. [Abstract] [Full Text] [PDF]
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M. Packer Should B-Type Natriuretic Peptide Be Measured Routinely to Guide the Diagnosis and Management of Chronic Heart Failure? Circulation, December 16, 2003; 108(24): 2950 - 2953. [Full Text] [PDF]
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D. S. Lee, P. C. Austin, J. L. Rouleau, P. P. Liu, D. Naimark, and J. V. Tu Predicting Mortality Among Patients Hospitalized for Heart Failure: Derivation and Validation of a Clinical Model JAMA, November 19, 2003; 290(19): 2581 - 2587. [Abstract] [Full Text] [PDF]
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R.S. Gardner, F. Ozalp, A.J. Murday, S.D. Robb, and T.A. McDonagh N-terminal pro-brain natriuretic peptide: A new gold standard in predicting mortality in patients with advanced heart failure Eur. Heart J., October 1, 2003; 24(19): 1735 - 1743. [Abstract] [Full Text] [PDF]
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S. Klotz, M. C. Deng, D. Hanafy, C. Schmid, J. Stypmann, C. Schmidt, D. Hammel, and H. H. Scheld Reversible pulmonary hypertension in heart transplant candidates--pretransplant evaluation and outcome after orthotopic heart transplantation Eur J Heart Fail, October 1, 2003; 5(5): 645 - 653. [Abstract] [Full Text] [PDF]
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L Bode-Schnurbus, D Bocker, M Block, R Gradaus, A Heinecke, G Breithardt, and M Borggrefe QRS duration: a simple marker for predicting cardiac mortality in ICD patients with heart failure Heart, October 1, 2003; 89(10): 1157 - 1162. [Abstract] [Full Text] [PDF]
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J. P. Curtis, S. I. Sokol, Y. Wang, S. S. Rathore, D. T. Ko, F. Jadbabaie, E. L. Portnay, S. J. Marshalko, M. J. Radford, and H. M. Krumholz The association of left ventricular ejection fraction, mortality, and cause of death in stable outpatients with heart failure J. Am. Coll. Cardiol., August 20, 2003; 42(4): 736 - 742. [Abstract] [Full Text] [PDF]
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P Schuster, S Faerestrand, and O-J Ohm Colour tissue velocity imaging can show resynchronisation of longitudinal left ventricular contraction pattern by biventricular pacing in patients with severe heart failure Heart, August 1, 2003; 89(8): 859 - 864. [Abstract] [Full Text] [PDF]
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M. T. Kearney, J. Nolan, A. J. Lee, P. W. Brooksby, R. Prescott, A. M. Shah, A. G. Zaman, D. L. Eckberg, H.S. Lindsay, P. D. Batin, et al. A prognostic index to predict long-term mortality in patients with mild to moderate chronic heart failure stabilised on angiotensin converting enzyme inhibitors Eur J Heart Fail, August 1, 2003; 5(4): 489 - 497. [Abstract] [Full Text] [PDF]
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H. Rickli, W. Kiowski, M. Brehm, D. Weilenmann, C. Schalcher, A. Bernheim, E. Oechslin, and H. P. Brunner-La Rocca Combining low-intensity and maximal exercise test results improves prognostic prediction in chronic heart failure J. Am. Coll. Cardiol., July 2, 2003; 42(1): 116 - 122. [Abstract] [Full Text] [PDF]
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V. Bittner Exercise testing in heart failure: Maximal, submaximal, or both? J. Am. Coll. Cardiol., July 2, 2003; 42(1): 123 - 125. [Full Text] [PDF]
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J. J. Leite, A. J. Mansur, H. F. G. de Freitas, P. R. Chizola, E. A. Bocchi, M. Terra-Filho, J. A. Neder, and G. Lorenzi-Filho Periodic breathing during incremental exercise predicts mortality in patients with chronic heart failure evaluated for cardiac transplantation J. Am. Coll. Cardiol., June 18, 2003; 41(12): 2175 - 2181. [Abstract] [Full Text] [PDF]
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