Abstract 12623: Complementary Role of Exercise Performance and Right Heart Metrics to the Validated MAGGIC score: Insights From a Network Analysis
Background: Risk stratification in heart failure can be completed with established risk scores. However, right heart metrics, deformation imaging and the cardiopulmonary response to exercise have not been routinely incorporated. We investigated the interaction and incremental prognostic value of novel echocardiographic metrics and exercise performance in a consecutive cohort of patients with dilated cardiomyopathy (DCM).
Methods: The Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) score was applied to 208 ambulatory patients with DCM (age 47 ± 13 years) who had undergone echocardiography in conjunction with cardiopulmonary exercise testing. Patients were followed for the composite end point of death, heart transplant, left ventricular device implantation and hospitalization for acute heart failure. Partial correlation network analysis was used to assess interaction between variables. Cox proportional hazard models identified independent predictors of outcome.
Results: Mean LVEF and LV GLS were 33 ± 13 % and -10.6 ± 4.4 % respectively. Among echocardiographic variables, LVEF and LV GLS and LV strain rate were strongly related (r = -0.89, and -0.86, respectively, p < 0.01). Age, sex, BMI, LV GLS and RV GLS explained 56% of the variance in peak VO2. Over a median follow up of 5.3 years, 60 events occurred including 16 deaths. MAGGIC scores were normally distributed (Figure 1, left) and log rank testing showed significant differences in survival. Cox proportional hazards identified MAGGIC score (1.78 [1.27-2.50], p <0.01), peak VO2 (HR 0.40 [0.24-0.84], p<0.01) and right atrial volume indexed (RAVI) (HR 1.10 [1.02-1.19], p = 0.01) as independently associated with outcome. In combination these variables were incremental in prognostic value compared to MAGGIC score alone (x2 = 65 vs 42, p <0.01, Figure 1, right).
Conclusion: In patients with DCM exercise performance and RAVI provide incremental prognostic value when combined with the validated MAGGIC score.
Author Disclosures: K.J. Moneghetti: None. G. Giraldeau: None. Y. Kobayashi: None. M. Ariyama: None. D. Boulate: None. T. Kouznestsova: None. I. Schnittger: None. M. Wheeler: None. J.C. Wu: None. E. Ashley: None. J. Myers: None. F. Haddad: None.
- © 2016 by American Heart Association, Inc.