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Development of an echocardiographic risk-stratification index to predict heart failure in patients with stable coronary artery disease: the Heart and Soul study
- Source :
- JACC. Cardiovascular imaging. 2(1)
- Publication Year :
- 2008
-
Abstract
- ObjectivesWe sought to determine which transthoracic echocardiographic (TTE) measurements most strongly predict heart failure (HF) and to develop an index for risk stratification in outpatients with coronary artery disease (CAD).BackgroundMany TTE measurements have been shown to be predictive of HF, and they might be useful if aggregated into a risk-prediction index.MethodsWe performed TTE in 1,024 outpatients with stable CAD enrolled in the Heart and Soul study and followed them for 4.4 years. With Cox proportional hazard models, we evaluated the association of 15 TTE measurements with subsequent HF hospital stay. Those measurements that independently predicted HF were combined into an index. Variables were defined as normal or abnormal on the basis of dichotomous cutoffs determined from the American Society of Echocardiography. Abnormal variables in each measurement were assigned points on the basis of strength of association with HF.ResultsOf the 15 variables, 5 measurements were independent predictors of HF: left ventricular mass index (LVMI), left atrial volume index (LAVI), mitral regurgitation (MR), left ventricular outflow tract velocity-time integral (VTILVOT), and diastolic dysfunction (DD). In multivariate analysis, each of the 5 measurements independently predicted HF: LVMI >90 g/m2 (hazard ratio [HR]: 4.1; 95% confidence interval [CI]: 2.3 to 7.2, p < 0.0001); pseudo-normal or restrictive DD (HR: 2.9; 95% CI: 1.8 to 4.5, p < 0.0001); VTILVOT 29 ml/m2 (HR: 1.6; 95% CI: 1.0 to 2.5, p < 0.06). Combining these measurements, the Heart Failure Index ranged from 0 to 8, representing risk as follows: 3 points for LVMI, 2 points for DD, and 1 point for VTILVOT, MR, and LAVI. Among participants with 0 to 2 points: 4% had HF hospital stays (reference); 3 to 4 points: 10% (HR: 2.4; 95% CI: 1.3 to 4.4, p = 0.003); 5 to 6 points: 24% (HR: 6.2; 95% CI: 3.6 to 10.6, p < 0.0001); 7 to 8 points: 48% (HR: 13.7; 95% CI: 7.2 to 25.9, p < 0.0001).ConclusionsWe identified 5 TTE measurements that independently predict HF in patients with stable CAD and combined them as an index that might be useful for risk stratification and serial observations.
- Subjects :
- Male
Time Factors
Heart Ventricles
risk stratification
Coronary Artery Disease
Risk Assessment
Severity of Illness Index
Article
California
Ventricular Dysfunction, Left
Predictive Value of Tests
Risk Factors
echocardiography
Humans
Heart Atria
Prospective Studies
Aged
Proportional Hazards Models
Heart Failure
prognostic index
Mitral Valve Insufficiency
Length of Stay
Middle Aged
Prognosis
Echocardiography, Doppler
Disease Progression
Female
Follow-Up Studies
Subjects
Details
- ISSN :
- 18767591
- Volume :
- 2
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- JACC. Cardiovascular imaging
- Accession number :
- edsair.pmid.dedup....bb6e01510739189b1f7e8710146f02b3