Prognosis and Risk Stratification of Patients With Advanced Heart Failure (from PROBE).

Affiliation

Department of Cardiovascular Diseases, University of Siena, Siena, Italy. Electronic address: [Email]

Abstract

In recent years, many prognostic scores have been developed for advanced chronic heart failure (CHF), but none of them is comprised of first- and second level echocardiographic indexes. The aim was to create a new prognostic echocardiographic score for patients with advanced CHF. Patients with advanced CHF were analyzed by standard, 3D, and speckle tracking echocardiography and followed prospectively for 2 ± 0.7 years recording major adverse cardiac events (MACE): cardiovascular death, hospitalization for HF, emergency heart transplantation, and left ventricular assist device or intra-aortic balloon pump implantation. A total of 110 patients were enrolled. The best predictors of MACE were selected on the basis of area under the curve by receiver operating characteristic analysis >0.70: left atrial volume index (no MACE vs MACE groups, 51.3 ± 20 ml/m2 vs 67 ± 20 ml/m2, p = 0.0003), right ventricular sphericity index (0.53 ± 0.09 vs 0.61 ± 0.10, p = 0.0002), right ventricular fractional area change (41 ± 9% vs 33 ± 9.5, p <0.0001), free-wall right ventricular longitudinal strain (-20 ± 4.5% vs -16 ± 6%, p = 0.0013). A prognostic score formula was calculated as: PROBE score = 1(if left atrial volume index >65 ml/m2) + 1(if right ventricular sphericity index >0.53) + 0.5(if right ventricular fractional area change <36.5%) + 1(if free-wall right ventricular longitudinal strain >-14%). It presented an area under the curve by receiver operating characteristic analysis of 0.90 and classified patients at low (PROBE ≤1), intermediate (PROBE = 1 to 2), or high (PROBE >2) risk of MACE. The Kaplan-Meier analysis revealed a strong correlation between the event-free survival rate and the 3 groups. In conclusion, the PROBE score, with first- and second level echocardiographic parameters, demonstrated a good predictive value for MACE. It represents a useful tool for a noninvasive, individualized, and accurate evaluation and stratification of prognosis in patients with advanced CHF.