Abstract 16571: Echocardiographic Predictors of Outcomes Add Value to the Seattle Heart Failure Model in Patients Referred for LVAD and/or Transplant Evaluation
Introduction and objectives: Patients with advanced heart failure are commonly evaluated based on a series of demographic, functional and clinical parameters. The modified Seattle Heart Failure Model (SHFM) is a well known scoring system. We previously demonstrated by echocardiography, that hemodynamic surrogates of high filling pressures (E/e’>15) and of low output state (cardiac index <1.7 L/min/m2) were predictors of adverse composite event rates. The relevance of adding these parameters to an established clinical scoring system remains unknown.
Methods: We included 360 patients referred to the Methodist Hospital Heart Failure/ Transplant center from 2004-2009. Echocardiographic hemodynamic profiles, Seattle Heart Failure scores and event rates at 1 year (predicted and observed) were obtained. Receiver Operator Characteristics (ROC) curves were constructed for: SHFM alone; echocardiographic parameters alone (E/e’>15 with cardiac index< 1.7 L/min/m2); and combined, for measured composite events (death, heart transplantation, LVAD implantation).
Results: Mean age was 55 ± 12 years, 77% were male, 44% Ischemic etiology, and a mean LVEF of 20 ± 9%. The composite predicted event rate at 1 year with the modified SHFM was 33.2% while the observed composite event rate was 46.5% (deaths encompassed 12.7%, 13.6% were heart transplants and 20.1% LVAD implants). Constructed ROC curves demonstrated an Area Under the Curve (AUC) for SHFM alone of 0.73 and an AUC for combined SHFM with echocardiography (E/e’>15 and cardiac index<1.7) of 0.76 with a p-value of 0.04.
Conclusions: SHFM is a strong discriminator of composite event rates in a population of patients with advanced heart failure. The predictive power improves with the addition of echocardiographic parameters reflective of high filling pressures and low output state. More detailed and larger studies would need to be done to confirm these findings.
- © 2012 by American Heart Association, Inc.